Republic of the Philippines

Department of Education
BUREAU OF LEARNER SUPPORT 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
Regio REGION 2 Divisio ISABELA
n n

Name of School VILLA FUERTE EMENTARY SCHOOL School ID 103793

Address VILLA FUERTE , SAN MATEO, ISABELA

Email address (if any) 103793@deped.gov.ph Telephone No. 09171233755

Website URL (if any)

B. School Profile
School Personnel

Name Position

MERCEDITA G. PIMENTEL Principal II

MARJOLYN B. PARINGIT Master Teacher III

JOSE D. MANEJA Teacher III

PRECIOUS ANGEL B. FUROC Teacher III

NERISSA CALIBUSO LSB

JELLY V. BASCO Teacher II

ROSE ANN C. CASTROVERDE Teacher I

LOUELLE MELODY D. GALOT LSB

KRIZZA LEI JAN A. RICAFRENTE Teacher III

EMELY A. BERSIDA Teacher III

JULIE M. MANEJA Teacher III

MARICEL V. LAUREL Teacher III

JESSICA G. TAMAYO Teacher III

C.Sports Club
C.1 Mandatory Sports
At least three out of six mandatory sports; however you may establish any preferred sports club.

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

Telephone No.: (02) 632-9935; (02) 638-8525
Add rows if necessary.
1.Arnis
2.Athletics
3. Chess
4. Dancesports
5. Sepak Takraw

C.2 Preferred Sports

Add rows if necessary.
1.Volleyball 7.Taekwondo
2. Badminton 8. Swimming
3.Archery 9.
3. Basketball 10.
4. Table Tennis 11.
5. Lawn Tennis 12.

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 JOSE D. MANEJA JR.
Signature
Date September 22. 2023

Certified by:
Principal/Officer-in-Charge MERCEDITA G. PIMENTEL
Signature
Date September 22. 2023

Verified by:
Division Sports Officer MANOLO Y. BAGUNU
Signature
Date September 22. 2023
This form is not valid if not signed.
Required Attached Document: 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