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
Region VIII Divisio NORTHERN SAMAR
n

Name of School STA. RITA ELEMENTARY SCHOOL School ID 122789

Address BARANGAY SANTA RITA, ALLEN, NORTHERN SAMAR

Email address (if any) 122789@deped.gov.ph Telephone No. 09653128858

Website URL (if any)

B. School Profile
Classification of School: Kindergarten to Grade 6
Class Organization: Multi-grade
Distict: Allen II
Number of Enrolment SY 2023-2024: 43
School Head: JOY M. SANIANO
Number of Teaching Personnel: 3

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.
Add rows if necessary.
1. Table Tennis (Boys and Girls)
2. Badminton (Boys and Girls)
3.Chess ( Boys)
4.
5.
6.

C.2 Preferred Sports

Add rows if necessary.
3. Table Tennis (Boys and Girls) 7.
4. Badminton (Boys and Girls) 8.
3.Chess ( Boys) 9.
4. 10.
5. 11.
6. 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 VIN PAUL B. PADIDA
Signature
Date

Certified by:
Principal/Officer-in-Charge JOY M. SANIANO
Signature
Date

Verified by:
Division Sports Officer OMAR O. TY, PhD
Signature
Date
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