BUREAU OF LEARNER SUPPPORT SERVICES

______________________________________________________________________________

FORM SSC 1: SCHOOL SPORTS CLUB REGISTRATION FORM

INSTRUCTIONS: Input the necessary details. Indicate N/A if not applicable. DO NOT ABBREVIATE.

A. Basic Information
Region III Division Nueva Ecija
Name of Mary’s Little Angels Academy School 401084
School ID
Address Brgy. Andal-Aliño, Talavera, Nueva Ecija
Email Address (if any) maryslittleangelsacademy@gmail.com Telephone No. N/A
Website URL N/A
(if any)
B. School Profile

Republic of the Philippines

DEPARTMENT OF EDUCATION

Mary’s Little Angels Academy

Andal-Aliño, Talavera, Nueva Ecija
Government Recognition No.
Pre-Elem. E-047 s. 1996 / Elementary E – 020 s. 2000
School ID: 401084

School Head/Officer-in-charge: Moses P. Ilumin

President & Owner: Mr. Efren L. Reyes

0936-742-8579 maryslittleangelsacademy@gmail.com

3F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City

Telephone No.: (02) 632-9935; (02) 638-8525
 C. Sports Club
C.1 Mandatory Sports
At least three out of six mandatory sports; however, you may establish any preferred sports club.
1.
2.
3.
4.
5.
6.

C.2 Preferred Sports

1.
2.
3.
4.
5.
6.

Declaration:
I hereby declare the information provided in this application is true and correct and there have been no
misleading statements, omission of any relevant facts nor any misinterpretation made.

Prepared by:
Sports Club Coordinator ORBIL M. VILLAFUERTE
Signature
Date OCT. 26, 2023

Certified by:
Principal / Officer-In-Charge MOSES P. ILUMIN
Signature
Date OCT. 26, 2023

Verified by:
District Sports Officer MR. MARVIN DELA CRUZ
Signature
Date

This form is not valid if not signed.

Required Attached Documents: Accomplished Form SSC 2 School Sports Club Attachment Form

3F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City

Telephone No.: (02) 632-9935; (02) 638-8525