BUREAU OF LEARNER SUPPPORT SERVICES

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FORM SSC 2: School Sports Club Attachment Form

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

DO NOT ABBREVIATE.

I. SPORTS CLUB INFORMATION

Create a copy of this page if four or more sports clubs are being offered. Add rows and columns if necessary

Sport’s Club Name: Chess

Established Date: October 9, 2023
Sports Club Facilitator/s : Almoncito Salac
Sports Club Members:
Members’ Name Grade Level
1. Algene Washington M. Miranda Grade 4
2. Xian Maddox A. Oreta Grade 4
3. James Rod Nipa Grade 5
4. David Niel Mejia Grade 5
5.Jhon Daryle B. Pontay Grade 6
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Sport’s Club Name: Athletics

Established Date: October 9, 2023
Sports Club Facilitator/s : Amy Jean M. Miranda
Sports Club Members:
Members’ Name Grade Level
1.Precious Mendoza Grade 6
2. Angela DC Reyes Grade 6
3.Prince Lorense Mejia Grade 6
4.Abriel Celdon DC Ayoc Grade 6
5. Rohan Luke Gunsay Grade 6
6. Ma. Andrea M. Daray Grade 6
7. John Westlee N. Gutierrez Grade 5
7. Shean Einstein B. Estrella Grade 4
8. Jullien France S. Liwanag Grade 4
9. Jan Caesar M. Cabading Grade 4

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

Telephone No.: (02) 632-9935; (02) 638-8525
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Sport’s Club Name: Gymnastics

Established Date: October 9, 2023
Sports Club Facilitator/s : Leovelyne P. Almeria
Sports Club Members:
Members’ Name Grade Level

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Sport’s Club Name: Badminton

Established Date: October 9, 2023
Sports Club Facilitator/s : Sheila Marie B. Roque
Sports Club Members:
Members’ Name Grade Level
1. King Cyrus V. Pineda Grade 6
2. Deniele A. Pineda Grade 6
3. Lhance Aidem B. Sayo Grade 6
4. Princess Kirsten B. Baliton Grade 6
5. Princess Junelle Gonzales Grade 6
6. Pranzine Mae S. Aguilar Grade 6
7. Rhian Jane G. Miranda Grade 6
8. Ayhen Bianca D. Bondoc Grade 6
9. Miley Micheline M. Dela Cruz Grade 6
10. Jairee Myel O. Balagtas Grade 5
11. Francis Liam F. Daray Grade 5
12. Rhenzan Kean T. Portillo Grade 5
13. Samantha Joy B. Brennan Grade 5
14. Giana Mae A. Pineda Grade 4
15. Kyle Patrick Del Rosario Grade 4
16. Matteo Kertin B. Baliton Grade 4
17. Naomi Cassandra D. Gunsay Grade 4
18. Shantel V. Dela Cruz Grade 4

Sport’s Club Name: Basketball

Established Date: October 9, 2023
Sports Club Facilitator/s : Sheila Marie B. Roque
Sports Club Members:
Members’ Name Grade Level
1. Jhon Felix V. Elcarte Grade 6
2. Kenzo P. Bondoc Grade 6

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

Telephone No.: (02) 632-9935; (02) 638-8525
 3. Kyle Cedrick A. Garcia Grade 6
4. Jan Third D. Miranda Grade 6
5. Prince Laurence L. Domingo Grade 6
6. Lance Jerson O. Legaspi Grade 6
7.Francis G. Lutitud Grade 6
8. Jhean Claude B. Valencia Grade 6
9. Romar John P. Santiano Grade 6
10. Kean Patrick A. Del Rosario Grade 6
11. Gian Kyle B. Pineda Grade 6
12. Reign Eisah M. Reyes Grade 6
13. Rhenzen Kean T. Portillo Grade 6
14. Vince Josh C. Torres Grade 6
15. Saint Yuri Miranda Grade 6
16. Prince Lorence F. Mejia Grade 6
17. Jemwel O. Pineda Grade 6
18. Shanrelle John G. Rusiana Grade 6
19. Suresh P. dela Cruz Grade 6
20. John Renz M. Guinto Grade 6
21. Andrei Y. Quiroz Grade 6
22. Naigel T. Guillermo Grade 6
23. John Renz M. Guinto Grade 6
24. Danielle D. Bondoc Grade 6
25. Johndel M. Reyes Grade 6
26. Abriel Celdon DC Ayoc Grade 6
27. Bryan Torres Grade 5
28. Isaiah Gio G. Salvador Grade 5
29. Ashriel Brent D. Bondoc Grade 4

Sport’s Club Name: Volleyball (Boys)

Established Date: October 9, 2023
Sports Club Facilitator/s : Sheila Marie B. Roque
Sports Club Members:
Members’ Name Grade Level
1. Steven James S. Barker Grade 5
2. John Raven C. Aguilar Grade 4
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Sport’s Club Name: Volleyball (Girls)

Established Date: October 9, 2023
Sports Club Facilitator/s : Sheila Marie B. Roque
Sports Club Members:
Members’ Name Grade Level

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

Telephone No.: (02) 632-9935; (02) 638-8525
 1. Jhoana Marie R. Salvador Grade 4
2. Ericka Diane P. Balingit Grade 4
3. Princess Alliyah M. Libunao Grade 4
4. Ada Monica G. Bruma Grade 4
5. Jayce Ashley L. Juance
6. Thanya M. Torres Grade 6
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II. PROGRAMMING

Time Sports Club Mon Tues Wed Thurs Fri

3:00 – 4:00 Chess Sports Club / /
3:00 – 4:00 Badminton Sports Club / /
4:00 – 5:00 Basketball Sports Club / /
4:00 – 5:00 Volleyball Sports Club / /
4:00 – 5:00 Athletics Sports Club / /

III. LIST OF AVAILABLE SPORTS EQUIPMENT AND SPORTS FACILITIES

Tick the box if standard sports equipment and facilities are available and ready to use. Put remarks and add rows if
necessary.

Learning Facilities Remarks

Track and Field Oval
Gymnasium / Covered Court
Basketball Court
Volleyball Court
Swimming Pool
Football / Softball / Baseball Field
Spacious Playing Area
Others:
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Sports Equipment Remarks

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

Telephone No.: (02) 632-9935; (02) 638-8525
IV. SPORTS ACTIVITIES, PROGRAMS AND/OR PROJECTS
Give at least (3) three recent activities, programs, projects or any other initiatives related to sports.

Activities / Programs/ Projects Date of Implementation

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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 SHEILA MARIE B. ROQUE
Signature
Date October 9, 2023

Certified by:
Principal / Officer-In-Charge DENNIS A. SANCHEZ
Signature
Date October 9, 2023

Verified by:
Division Sports Officer JOEL VICTORIO CRUZ
Signature
Date

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

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