Republic of the Philippines

Department of Education
BUREAU OF LEARNER SUPPORT SERVICES
SCHOOLS DIVISION OFFICE OF PANGASINAN II

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 I Division PANGASINAN II
Name of School MATH Excellence Academy of School ID 412027
Binalonan Inc.
Address Canarvacanan, Binalonan, Pangasinan
Email address (if any) Telephone No.
Website URL (if any)
B. SCHOOL PROFILE
 C. SPORTS CLUB
C.1 Mandatory Sports (Arnis, Athletics, Chess, Dancesport, Sepaktakraw, and Swimming)
At least three out of six mandatory sports; however you may establish any preferred sports club.
Add rows if necessary.

1. Athletics
2. Chess
3. Sepak Takraw
4.
5.
6.

C.2 Preferred Sports

Add rows if necessary.
1. Basketball
2. Badminton
3. Table Tennis
4. Volleyball
5.
6.

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 no any misinterpretation made.

Prepared by:
Sports Club Coordinator MA. ASELA B. AQUINO
Signature
Date

Certified by:
Principal/Officer-in-Charge MINROD B. SUBIDO
Signature
Date

Verified by:
Division Sports Officer ENRIQUE R. MACAYAN, EdD
Signature
Date
This form is not valid if not signed.
Required Attached document: Accomplished Form SSC.2 School Sports Club Attachment Form
 Republic of the Philippines

Department of Education
BUREAU OF LEARNER SUPPORT SERVICES
SCHOOLS DIVISION OFFICE OF PANGASINAN II

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

Sport’s Club Name: MEAB SPORTS CLUB
Established Date: September 24, 2023
Sports Club Coordinator: Ma. Asela B. Aquino
Coach/Trainer:
Club Officer/s:
Officers’ Name Position
1. Evan Jerick Dulay President
2. Princess Robelisa Mateo Vice- President
3. Cristine Pizarro Secretary
4. Liam Magallanes Sub-Secretary
5. Jhamal Colen Lee Gayagay Treasurer
6. Azrael Siquig Sub-Treasurer
7. Shaira Castellano Auditor
8. Jay Angelo Arucan Auditor
9. Cyrus Sedrome Public Information Officer
10. Ian Generillo Public Information Officer
11. Vince Aldrich Manzano Peace Officer
12. Candace Cordero Peace Officer
13. Planning officer
14. Planning Officer
Create a copy of this page if four or more sports clubs are being offered. Add rows and columns if necessary.

Prepared by:
Sports Club Coordinator MA. ASELA B. AQUINO
Signature
Date
Certified by:
Principal/Officer-in-Charge MINROD B. SUBIDO
Signature
Date

Verified by:
Division Sports Officer ENRIQUE R. MACAYAN, EdD
Signature
Date
This form is not valid if not signed.
Required Attached document: Accomplished Form SSC.2 School Sports Club Attachment Form
 Republic of the Philippines

Department of Education
BUREAU OF LEARNER SUPPORT SERVICES
SCHOOLS DIVISION OFFICE OF PANGASINAN II

FORM SSC. 2: School Sports Club Attachment Form

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

DO NOT ABBREVIATE.

II. SPORTS CLUB INFORMATION

Sport’s Club Name: MEAB Sports Club
Established Date: September 11, 2023
Sports Club Facilatator/s: Ma. Asela B. Aquino, T. Troy Vince D. Tibay
Sports Club Member/s:
Members’ Name Grade Level
1. Balodong, Crysha Faith Grade 10
2. Capistrano, Angel Grade 7
3. Cava, Chalesea Sophia Grade 7
4. Cordero, Candace Lois Grade 11
5. Guico, Angel Grade 11
6. Mateo, Princess Robelisa Grade 12
7. Pizarro, Christine Grade 11
8. Ravanilla, Criselle Ann Grade 10
9. Sandoval, Frexille Ann Grade 7
10. Hernandez, Jan Gabrielle Grade 12
11. Gabot, Kian Grade 10
12. Oximas, Mark Daniel Grade 10
13. Calso, Lhord Gian Lee Grade 9
14. Generillo, Ian Grade 12
15. Elegado, Justin Mico Grade 11
16. Manzano, Dean Leo Grade 11
17. Gayagay, Jhamal Colen Lee Grade 10
18. Sibolboro, Cassandra Grade 12
19. Rebamontan, Matthew Grade 9
20. Advincula, Erinrose Grade 9
21. Ramos, John Rhey Grade 10
 22. Galera, Beyonce Grade 10

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

III. PROGRAMMING

Put the preferred time schedule. Add rows and columns if necessary.
Time Sports Club Mon Tues Wed Thurs Fri Sat
3:15-4:15 Basketball and Table Tennis /
3:15-4:15 Volleyball and Taekwondo /
3:15-4:15 Sepak Takraw and Athletics /
3:15-4:15 Badminton and Chess /

Put the preferred time schedule. Add rows and columns if necessary.
Time Varsity Club Mon Tues Wed Thurs Fri Sat
4:15-5:15 Basketball and Table Tennis /
4:15-5:15 Volleyball and Taekwondo /
4:15-5:15 Sepak Takraw and Athletics /
4:15-5:15 Badminton and Chess /

IV. 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 UTILIZED
/ Basketball court UTILIZED
/ Volleyball court UTILIZED
Swimming pool N/A
Football/softball/baseball field N/A
/ Spacious playing area
Others: For Table Tennis and Taekwondo UTILIZED
Sports Equipment
/ VOLLEYBALL
/ VOLLEYBALL NET
/ BASKETBALL
/ BASKETBALL RING
/ BADMINTON NET
/ RACKET
/ SHUTTLECOCK
/ TABLE TENNIS BALL
 / PADDLE
/ NET
/ TABLE
/ CHESSBOARD

V. SPORTS ACTIVITIES, PROGRAMS AND/OR PROJECTS

Give at least three (3) recent activities, programs, projects or any other initiatives implemented related to
sports. Add rows if necessary.

Activities/Programs/Projects Date of Implementation

School-Based Tryout for Sports September 22, 2023

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 no any misinterpretation made.

Prepared by:
Sports Club Coordinator MA. ASELA B. AQUINO
Signature
Date

Certified by:
Principal/Officer-in-Charge MINROD B. SUBIDO
Signature
Date

Verified by:
Division Sports Officer ENRIQUE R. MACAYAN, EdD
Signature
Date
This form is not valid if not signed.
Required Attached document: Accomplished Form SSC.2 School Sports Club Attachment Form