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: SHOOTERS BASKETBALL CLUB
Established Date: NOVEMBER 2022
Sports Club Facilitator/s: MIA B. TAN
Sports Club Member/s: OLIVER MORADA
Members’ Name Grade Level
1. ACOBA DIESEL GRADE 6
2. BERNAL LANDREB GRADE 6
3. COLONIA TJ GRADE 6
4. CANLAS ASHIEL GRADE 6
5. DIZON JOSEPH GRADE 6
6. BALATBAT JEFFERSON GRADE 5
7. CANONO BRYLLE GRADE 5
8. LOPEZ ALDRIN GRADE 5
9. YUTUC AVIEL GRADE 5
10. TONGOL RENZ GRADE 5

Sport’s Club Name: SPEEDO MAN 

Established Date: NOVEMEBER 2022
Sports Club Facilitator/s: ALLAH C. BAUTISTA
Sports Club Member/s: CECIL NUCUM
Members’ Name Grade Level
1. GALANG PRINCE GRADE 6
2. INCILLO LESTER GRADE 6
3. LAPUZ JOMIKE GRADE 6
4. MAGNO RUM GRADE 6
5. MANIAGO KYLE GRADE 6
6. LUAT JERSON GRADE 5
7. TALAVERA NICK GRADE 5
8. TONGOL RENZ GRADE 5
9. CABANATAN ARVIN GRADE 5
10. YUTUC AVIEL GRADE 5

Sport’s Club Name: DANCERS CLUB

Established Date: NOVEMBER 2022
Sports Club Facilitator/s: MYLA BALUYUT
Sports Club Member/s: AVIGAIL GUTIERREZ
Members’ Name Grade Level
1. ADAYA KHATE GRADE 6
2. BIBANCO EULA GRADE 6
3. BONDOC JEZRA GRADE 6
4.  DOMINGO JILLIAN GRADE 6
5. DY RHENAEL GRADE 6
 6. ASIGNASCION SHAYNA GRADE 5
7. BASILIO BELLA GRADE 5
8. BUNDALIAN ANGELICA GRADE 5
9. CORPUZ ALTHEA GRADE 5
10. DOLOTINA KRISTINE GRADE 5

II. PROGRAMMING
 
Put the preferred time schedule. Add rows and columns if necessary.
Time Sports Club Mon Tues Wed Thurs Fr Sat
i
Example     
3:00PM-4:00PM Arnis Sports Club /
4:00PM-5:00PM Chess Sports Club /
5:00PM-6:00PM Sepaktakraw Sports Club /

Put the preferred time schedule. Add rows and columns if necessary.
Time Varsity Club Mon Tues Wed Thurs Fri Sat
3:10 PM – 4:10 SHOOTERS BASKETBALL / / /
PM CLUB
3:10 PM – 4:10 SPEEDO MAN /
PM
3:10 PM – 4:10 DANCERS CLUB /
PM

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 N/A
Gymnasium / covered court  N/A
Basketball court N/A
Volleyball court N/A
Swimming  pool N/A
Football/ softball/ baseball N/A
field
Spacious playing area N/A
Others: _______N/A____________
            ___________________
            ___________________

Sports Equipment Remarks

CHESSBOARD
VOLLEYBALL NET
SHOT, DISCUSS AND JAVELIN
IV. SPORTS ACTIVITIES, PROGRAMS AND/OR PROJECTS
      Give at least (3) three recent activities, programs, projects or any other initiatives implemented related to sports. 
      Add rows if necessary.

Activities/Programs/Projects Date of
Implementation
1. ORIENTATION OF THE SPORTS AND CLUB OFFICERS AND NOVEMBER 15,
GIVING CONSENT TO THE PARENTS 2022

2. SELECTION OF THE PUPILS ON SPORTS AND CLUB OFFICERS NOVEMBER 17,

2022

3. MEETING AND SEMINARS ABOUT SPORTS AND CLUB OFFICERS NOVEMBER 18,
2022

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 ALLAH C. BAUTISTA
Signature
Date

Certified by:
Principal/Officer-in-Charge GEMMA T. BALINGIT
 Signature
Date

Verified by:
Division Sports
JANE D. VALENCIA
Officer
Signature
Date