CROSS Education - Student Reservation Form

Student Reservation Form

For multiple children, please accomplish one form per child.
Student Information
Parent's E-mail*
example@example.com
Student's Name*

First NameMiddle NameLast Name
Gender*
Age*
Date of Birth*

MonthDayYear
Grade Level for Incoming School Year*
Last School or Homeschool Provider*
Residence Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parental Information
Father
Father's Name

First NameMiddle NameLast Name
Residence Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number

Country CodeArea CodePhone Number
Telephone Number

Country CodeArea CodePhone Number
Email Address
example@example.com
Occupation
Employer
Hobbies/ Interests / Affiliations
Mother
Mother's Name

First NameMiddle NameLast Name
Residence Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number

Country CodeArea CodePhone Number
Telephone Number

Country CodeArea CodePhone Number
Email Address
example@example.com
Occupation
Employer
Hobbies/ Interests / Affiliations
Emergency Contact Details
Name*

First NameMiddle NameLast Name
Mobile Number*

Country CodeArea CodePhone Number
Email Address*
example@example.com
Relationship*
Upload Payment Transaction Slip
Direct Deposit / Electronic Bank Transfer payment to:

Bank Name:UNIONBANK

Account Name: CROSS HOME-SCHOOL ACADEMY INC

Account Number: 0031 9000 1519

Important Note:

Reservation Fee is P5,000.

Reservation Fee is NON-TRANSFERRABLE and NON-REFUNDABLE but is fully deductible from the last installment of Program Fees.
File Upload - Please upload clear screenshot, photo, or scanned image of deposit or payment transaction slip for our confirmation. NOTE: Reservation is not final until payment is confirmed.

Cancelof
Signature of Parent

Clear
Data Security and Confidentiality

We understand the importance of keeping your information secure and confidential. CROSS Education (CROSS Home-School Academy, Inc.) employs appropriate technical and organizational measures to safeguard your personal data against unauthorized access, disclosure, alteration, or destruction.
Should be Empty:

Student Reservation Form

Student Information

Parental Information

Father

Mother

Emergency Contact Details

Upload Payment Transaction Slip

Data Security and Confidentiality