Republic of the Philippines

Department of Education
Region VII, Central Visayas
Division of Cebu City, South District 7

BITLANG INTEGRATED SCHOOL

Tabla, Sudlon I, Cebu City

Annex A: OFF-CAMPUS ACTIVITY PROPOSAL

Attachments (If applicable):

Certified True Copy of Accreditation Certificate by the Department of Tourism (DOT)

Certified True Copy Certification from the Land Transportation, Franchising and
Regulatory Board (LTFRB) on the validity and scope of franchise of the tour
operator’s vehicle/s, if applicable
Copy of Registration of Vehicles
Copy of Professional Driver’s License and Updated Medical Record
Copy of Roadworthiness Certificate
Information and Cost of Travel Insurance
Indicative Program (including the itinerary of activities)
Other expenses that may be incurred
Information on the place/s to visit

ACTIVITY INFORMATION
Name of School: Division:
CEBU CITY
BITLANG INTEGRATED SCHOOL
Region:
CENTRAL VISAYAS
Title of the Activity: Subject Area:
DISTRICT SPORTS AND CULTURAL MEET MAPEH
Purpose of the Activity: Proponent: Activity Head:
Showcase talents and discover potentials for DISTRICT SPORTS AND Ma. Jessica D. Batindaan
sports and cultural activities CULTURAL GROUP
Destination/Venue: Departure Date: Departure Time:
September 13, 2019 6:30 AM
Inayawan Gym
Return Date: Return Time:
Inayawan, Cebu City
September 13, 2019 5:30 PM
Grade Level: No. of Learners:
Kinder 1 2 3 4 5 6 7 8 9 10 11 12 18
Fund Source: Budget Estimate: (breakdown if necessary)
SCHOOL CANTEEN Php 4500.00
CONTENT OF ACTIVITY
Linkage with the ESIP-AIP Target Key Stage and Educational Competencies
(as per K-12 Curriculum Guide)

PROJECT SIDLAK

CHAPERON’S INFORMATION
 Position /
Name Contact Number
Designation
JUVELYN A. BELLITA Teacher 09254907825
MARIE PAZ S. GABITO Teacher 09159709059
LOYVIC CABRIANA GABITO Teacher 09224267067
GRACE NACARIO Teacher
MARVIN MIOLE Teacher
TYLUSMOORE ESPINOLA Teacher
EDNA CABILES Teacher
JENALYN EBONALO Teacher
ASHLY JANE FLORES Teacher
EMELIA CABILES Teacher
CHARLENE BACARISAS Utility
MELANIE SIEMPRE Utility

For DEPED-INITIATED ACTIVITIES

Position / Name of Contact Number
Name of Person in Charge
Designation Office/Unit
LOYVIC CABRIANA GABITO Sports Coordinator Bitlang IS 09428098702
MARIE PAZ S. GABITO Sports Coordinator Bitlang IS 09159709059

For NON-DEPED INITIATED ACTIVITIES

Position / Name of Contact Number
Name of Service Provider
Designation Office/Unit

LOGISTICAL REQUIREMENTS
Means of Transportation Barangay Bus
Name of Service Provider Barangay Sudlon I, Cebu City
Contact Details of Service Provider
Transportation
 Name Josephine Pacardo – Brgy Secretary
 Contact Number

Republic of the Philippines

 Department of Education
Region VII, Central Visayas
Division of Cebu City, South District 7

BITLANG INTEGRATED SCHOOL

Tabla, Sudlon I, Cebu City

Annex B: MANIFEST

Name of School : BITLANG INTEGRATED SCHOOL

Title of Activity : DISTRICT SPORTS AND CULTURAL MEET
Destination / Venue : DEPED – DIVISION OF CEBU CITY
Vehicle Number : No. of Learners :
Departure Date : SEPTEMBER 13, 2019 Return Date : SEPT 13, 2019
Departure Time : 6:30 AM Return Time : 5:30 PM

Learner/Parent/
Departure Return
Passenger’s Name Guardian / Teacher/ Contact Number/s
(Sign) (Sign)
Others
Mhark Lorenz Riego Grade 8 – Gold
Julai Cabiles Grade 8 – Gold
Arkent Baloro Grade 10 – Sapphire
Edrean Immanuel Cabiles Grade 10 – Sapphire
Rhea Jane Callino Grade 10 – Sapphire
Resa Mae Dela Cerna Grade 9 – Emerald
Christian Ibonalo Grade 10 – Sapphire
Alexis Letran Grade 10 – Sapphire
Christiel Jane Balili Grade 11 – Diamond
Jaredelle Ubod Grade 8 – Gold
Luegie Balili Grade 5 – Strawberry
Trisha Kaye Navarro Grade 10 – Sapphire
Hanna Riah Denise Cabiles Grade 6 – Pomelo
Kirk Jayhanes Tundaan Grade 4 – Cherry
Cyril Kit Tundaan Grade 11 – Diamond
Daniela Bellita
Tylusmoore Espinola Faculty
Emelia Cabiles Faculty
Marvin Miole Faculty
Melanie Siempre Utility
Charlene Bacarisas Utility
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Cebu City, South District 7

BITLANG INTEGRATED SCHOOL

Tabla, Sudlon I, Cebu City

Annex C: PARENT’S / GUARDIAN’S CONTEST FORM

Name of Learner : JOHN BRAYAN BAROMAN

Date of Birth
Parent’s / Guardian’s Name
Relationship to Learner
Home Address
Contact Number/s
Title of the Activity
Venue
: October 24, 2008 Sex : Male
: Joan Baroman
: Mother
: Nangka, Sinsin, Cebu City
:
: District Meet
: Inayawan, Cebu City Date of Activity : 09/07/2018

As the parent / guardian of the above-mentioned learner, I hereby acknowledge that I have
been informed of the details of the off-campus activity and voluntarily and freely elect to participate
in this off-campus activity. Furthermore, I understand and agree that the risks associated with an off-
campus activity and agree that the rules and regulations established for the said activity are for the
safety and security of the participants, and thus agree to instruct my child or children to obey them.

Having understood all the aforementioned, I hereby consent to allow my child or children to
participate, acknowledging all of the foregoing. I am also solely responsible for providing travel
insurances and any expenses for my child or children’s participation in the activity.

Parent / Guardian’s Name and Signature Date

NOTES: (Information you may wish to inform the teacher, such as child’s medical condition, etc.)