ENROLLMENT FORM

ENROLLMENT FORM
School Year*
Department*
Grade Level*
Date Accomplished*

MonthDayYear
Accomplished/ Enrolled by:
Contact no.*
Check the appropriate box only*

No LRNWith LRNReturning (Balik-Aral)
INSTRUCTIONS: Print legibly all information required in CAPITAL letters. Submit the accomplished form to the Person-in-Charge/Registrar/Class Adviser. Use a black or blue pen only.
STUDENT INFORMATION
Last Name*
First Name*
Middle Name
Extension Name
e.g Jr., III (if applicable)
PSA Birth Certificate No.
Learner Reference No. (LRN)
Date of Birth*

YearMonthDay
Date
Gender*

MaleFemale
Age*
Belonging to any indigenous Peoples (IP)Community/Indigenous Cultural Community?

NoYes If Yes, please specify:
Mother Tongue*
Religion*
ADDRESS
Address
House # and Street, Barngay, City/Municipality, Zip Code
Incase of emergency, notify
ACADEMIC INFORMATION

SCHOOLS ATTENDED

	School Name	Address	Grade Level	School Year
Preschool
Grade School
High School

ACADEMIC HISTORY AND CONCERNS

	NO	YES	IF YES TYPE YOUR ANSWER HERE
Has your child skipped a grade/level? If yes, what grade/s?
Has your child ever had a failed grade/mark? If yes, what subject/s?
Has your child ever been retained (repeated a grade)? If yes, what grade/s?
Has your child had any specific learning difficulties/special needs/ disabilities or giftedness ? If yes, please provide details.
Has your child received extra help in school? (ie.: academic tutorial, EP, Remedial classes) If yes, please describe.
Has your child ever had a psycho-educational evaluation/ assessment? If yes, please indicates/findings (and submit a copy of full report for the Guidance Office.)
Does your child have any medical condition/ physical disabilities/ impairments? If yes, please indicate (and provide a copy of the medical report for the School Clinic):

ACADEMIC HONORS AWARDS

	ACADEMIC AWARDS	EXTRA-/CO-CURRICULAR ACTIVITIES
Please indicate recent academic honors, distinctions,
personal accomplishments and awards earned.
Include positions held (elected/appointed officer)
and other special responsibilities/ extra-curricular
activities in out of the school. Pls. Include the school year.

PARENT'S/GUARDIAN'S INFORMATION
FATHER'S INFORMATION
Name*
(Last Name, First Name, Middle Name)
Occupation*
Occupation
Contact Number*
09123456789
MOTHER'S INFORMATION
Name*
(Last Name, First Name, Middle Name)
Occupation*
Occupation
Contact Number*
09123456789
GUARDIAN'S INFORMATION (Optional)
Name
(Last Name, First Name, Middle Name)
Occupation
Occupation
Ceontact Number
09123456789
Contact Person in case of emergency

FatherMotherGuardian
Relationship*
Address*
Telephone Number
E-mail Address*
example@example.com
Type a question

MarriedSeparatedAnnulledWidowed/-rLive-inOther (pls. specify)

	Siblings' Full Name	Birthday (mm/dd/yy)	Age	Grade Level/ Course	School/ Occupation (if any)
1.
2.
3.

RESIDENCE
KINDLY INDICATE WHERE THE CHILD IS LIVING. Please check.

Family HomeGuardian's HomeOther
HOW DOES YOUR CHILD GET TO SCHOOL? Please check.

School serviceFamily-owned vehiclePublic Transport(commuter)Other
Other information or changes you would want the school to know:
Complete Name
Eligibility for Elementary School Enrolment
Credential Presented for Grade 1:

Kinder Progress ReportECCD Checklist
School Name
School ID
School Address
Complete Address
For Learners in Junior High School
School Name
School ID
School Address
Complete Address
School Year Graduated
SY: YYYY-YYYY
General Average
00.00
For New Learners (Balik-Aral) and Those Who Shall Transfer/Move In
Last Grade Level Completed
Last School Year Completed
SY: YYYY-YYYY
School Name
School ID
School Address
Complete Address
We understand that this enrollment and admission to Mercedarian School, Inc. are subject to the following conditions:
- That credentials and documents submitted to the Registrar’s Office become the property of Mercedarian School and will not be returned to the student;
- That we agree to comply with the rules, policies and regulations of Mercedarian School as prescribed in its Student Manual and any other further issuances, memos and circulars.
We have fully read and understood all sections of this enrollment form and its process. We declare to the best of our knowledge, that the information supplied herein, and the documents supporting it, is correct, valid and complete.
Parent/Guardian's Name*
Full Name (Firstname M.I. Lastname)
Date Submitted*

MonthDayYear
Date
Take a photo in a plain white background in 1x1 size or if you have a softcopy of your picture click choose file button.
Student Photo

Age

	Years	Months

Should be Empty:

ENROLLMENT FORM

STUDENT INFORMATION

ACADEMIC INFORMATION

PARENT'S/GUARDIAN'S INFORMATION