OLD STUDENT - ENROLLMENT FORM

ENROLLMENT FORM
School Year*
Date Accomplished*

MonthDayYear
Department*
Grade Level*
Accomplished/ Enrolled by:*
Contact Number*
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
Learner Reference No. (LRN)
Last Name*
First Name*
Middle Name
Extension Name
e.g Jr., III (if applicable)
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Age*
Religion*
ADDRESS
House Number and Street

Barangay

City/Municipality/Province/CountryState / Province

Postal / Zip Code
ACADEMIC HONORS AWARDS
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 and out of the school. Pls include the school year.
1. ACADEMIC AWARDS
1. EXTRA-/CO-CURRICULAR ACTIVITIES
2. ACADEMIC AWARDS
2. EXTRA-/CO-CURRICULAR ACTIVITIES
Incase of emergency, notify
PARENT'S/GUARDIAN'S INFORMATION
FATHER'S INFORMATION
Father's Complete Name*
(Last Name, First Name, Middle Name)
Father's Occupation*
Occupation
Father's Contact Number*
09123456789
MOTHER'S INFORMATION
Mother's Complete Name*
(Last Name, First Name, Middle Name)
Mother's Occupation*
Occupation
Mother's Contact Number*
09123456789
GUARDIAN'S INFORMATION (Optional)
Guardian's Name
(Last Name, First Name, Middle Name)
Guardian's Occupation
Occupation
Guardian's Contact Number
09123456789
Contact Person in case of emergency*

FatherMotherGuardian
Relationship*
Address*
Telephone Number
E-mail Address*
example@example.com
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
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
Should be Empty:

ENROLLMENT FORM

STUDENT INFORMATION

ACADEMIC HONORS AWARDS

PARENT'S/GUARDIAN'S INFORMATION