FORM SSC.1 School Sports Club Registration Form v1

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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 IV-A CALABARZON Divisio SANTA ROSA CITY
n n

Name of SOUTHVILLE IV ELEMENTARY SCHOOL School 251501


School ID

Address BRGY CAINGIN, CITY OF SANTA ROSA, LAGUNA

Email address (if Telephone


any) No.

Website URL (if


any)
B.School Profile

1. Number of Enrolment - 4683


2. Number of Teachers - 139
3. Number of Non-teaching - 3
4. Number of Player who qualified in Division Meet - 44
5. Number of Players who qualified in Regional Meet - 5
6. Number of Teachers who serve in Division Meet - 7
7. Number of teachers who serve in Regional Meet - 4

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. Basketball (boys
2. Volleyball (boys and girls)
3. Badminton
4. Arnis
5. Chess
6. Table Tennis

C.2 Preferred Sports


Add rows if necessary.
1. Sepak Takraw 7.
2. Softball 8.
3. Dance Sports 9.
4. Taekwondo 10.
5. Athletics 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 SALVADOR G. CASTAÑEDA
Signature
Date 10/28/2024

Certified by:
Principal/Officer-in-
FRANCIS G. BALTAZAR
Charge
Signature
Date 10/28/2024

Verified by:
Division Sports Officer MARIO V. ZANTUA
Signature
Date 10/28/2024
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

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