Republic of the Philippines

Department of Education
BUREAU OF LEARNER SUPPORT SERVICES
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

Create a copy of this page if four or more sports clubs are being offered. Add rows and columns if necessary.
Sport’s Club Name: CAPARISPISAN BADMINTON CLUB
Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: VOLLEYBALL CLUB OF CAPARISPISAN

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: BASKETBALL CLUB OF CES

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5

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

Telephone No.: (02) 632-9935; (02) 638-8525
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN TENNIS CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN SWIMMING CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5
Sport’s Club Name: CAPARISPISAN ATHLETIC CLUB
Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN SOFTBALL AND BASEBALL CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City
Telephone No.: (02) 632-9935; (02) 638-8525
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN SIPA CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN GYMNASTIC CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN SOCCER CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN TABLE TENNIS CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
3F Mabini Building, DepEd Complex, Meralco Avenue, Pasig City
Telephone No.: (02) 632-9935; (02) 638-8525
 Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN LAWN TENNIS CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN CHESS CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

Sport’s Club Name: CAPARISPISAN TAEKWONDO CLUB

Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

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

Telephone No.: (02) 632-9935; (02) 638-8525
 Sport’s Club Name: CAPARISPISAN ARNIS CLUB
Established Date: JANUARY 9, 2023
Sports Club Facilitator/s: JAY-AR A. VALERA
Sports Club Member/s: GILBERT C. FAYLOGNA
Members’ Name Grade Level
1.JAIVEN PRAILE UDDON 6
2.GEREM M ABENDANIO 5
3.SOPHIA LOUISSE TABIOS 5
4. SHAINE VALERIE I AGARPAO 6
5.ZANDER DOMINC SAMIANO 5
6.STEPHANIE FUERTE 5
7.SHYNELL PALERACIO 4
8.JACOB DANN DOMINGO 4
9.ADRIAN QUITORAS 5
10.KURTH EDU 5

II. PROGRAMMING

Put the preferred time schedule. Add rows and columns if necessary.
Time Sports Club Mon Tues Wed Thurs Fri Sat
Example
3:00PM-4:00PM Badminton Sports Club / / /
4:00PM-5:00PM Chess Club / / /
5:00PM-6:00PM Volleyball Sports Club / / /
3:00PM-4:00PM Softball Sports Club / /
4:00PM-5:00PM baseball Club / /
5:00PM-6:00PM BAsketball Sports Club /

Put the preferred time schedule. Add rows and columns if necessary.
Time Varsity Club Mon Tues Wed Thurs Fri Sat

III. 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
Gymnasium / covered court /
Basketball court /
Volleyball court /
Swimming pool
Football/ softball/ baseball field
Spacious playing area /
Others: ___________________
___________________
___________________

Sports Equipment Remarks

Badminton In good condition
Volleyball In good condition
Basketball In good condition

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

Telephone No.: (02) 632-9935; (02) 638-8525
IV. SPORTS ACTIVITIES, PROGRAMS AND/OR PROJECTS
Give at least (3) three recent activities, programs, projects or any other initiatives implemented related to sports.
Add rows if necessary.

Activities/Programs/Projects Date of Implementation

1. Badminton Try-outs and Trainings Feb 2, 2023

2. Volleyball Try-outs and Trainings Feb 2, 2023

3. Athletics Try-outs and Trainings Feb 2, 2023

4. Basketball Try-outs and Trainings Feb 2, 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 nor any misinterpretation made.

Prepared by:
Sports Club Coordinator JAY-AR A. VALERA
Signature
Date FEBRUARY 6, 2023

Certified by:
Principal/Officer-in-Charge FREDIL FIDEL S. DUQUE
Signature
Date FEBRUARY 6, 2023

Verified by:
Division Sports Officer
Signature
Date

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

Telephone No.: (02) 632-9935; (02) 638-8525