MODIFIED LEARNER ENROLLMENT AND SURVEY FORM SY 2025-2026

MODIFIED LEARNER ENROLLMENT AND SURVEY FORM SY 2025-2026
A. GRADE LEVEL AND SCHOOL INFORMATION
A1 School Year
A2. Check the appropriate boxes only
Returnee

A3.
A4 Grade Level to enroll:
B1 PSA Birth Certificate No if available upon enrolment
B2 Learner Reference Number LRN
Name*

B4 FIRST NAMEB3 LAST NAME
B5 MIDDLE NAME
B6 EXTENSION NAME eg Jr III if applicable
B8. Age

physical, mental, social disability, For Learners with Special Education Needs B14. Does the learner have special education needs? (i.e. medical condition, giftedness, among others) No Yes

B10. Belonging to Indigenous Peoples (IP) Community/Indigenous Cultural Community B11. If yes, please specify:

B15. If yes, please specify: NoB16. Do you have any assistive technology devices available at home? (i.e. screen reader, Braille, DAISY)
B7. Date of Birth (Month/Day/Year)
This is a fill in the blanks field. Please add appropriate blank fields and text.
B8. Age
B9. Sex

MaleFemale
B10. Belonging to Indigenous Peoples (IP) Community/Indigenous Cultural Community

YesNo
B11 If yes please specify
B12 Mother Tongue
B13 Religion
B14 Does the learner have special education needs? (i.e. medical condition, giftedness, among others)

YesNo
B15 If yes please specify
B16 Do you have any assistive technology devices available at home?

YesNo
B17 If yes please specify
B18 Email Address
example@example.com
B22 City Municipality
B19 House Number and Street
Birth Place
B23Province
B20 Subdivision Village Zone
B24Region
B21 Barangay
C. PARENT/ GUARDIAN INFORMATION
C1 FATHER Full Name last name first name middle name
OCCUPATION
Mother C4. Full Maiden Name (last name, first name, middle name)
Guardian C7 Full Name last name first name middle name
OCCUPATION
C2. Highest Educational Attainment

Elementary levelElementary GraduateHigh School LevelHigh School Graduate(College/Post Graduate) Or (Technical/Vocational)
C3 Contact numbers cellphone, telephone/ Email Address
C4 MOTHER Full Maiden Name last name first name middle name
OCCUPATION
C5 Highest Educational Attainment

Elementary LevelElementary GraduateHigh SchoolHigh School Graduate(College/Post Graduate) Or (Technical/Vocational)
C6 Contact numbers cellphone, telephone/ Email Address
C8 Highest Educational Attainment

No Formal Schooling but able to read and writeElementary LevelElementary GraduateHigh School LevelHigh School GraduateC5 Highest Educational Attainment
C9 Contact numbers cellphone, telephone/ Email Address
C10 Is your family a beneficiary of 4Ps?

YesNo
D. HOUSEHOLD CAPACITY AND ACCESS TO DISTANCE LEARNING
D1 How man of your household members (including the enrollee) are studying in School Year 2025-2026? Please specify each.
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
D4 Is there an internet signal in your area
D5 How do you connect to the internet Choose all that applies
Signature Over Printed Name of ParentGuardian

Clear
Date Accomplished

MonthDayYear
Date
To be filled out by HLIS staff only: For new and transferee students only: Please check:
Name
Contact Number
Birthday
Gender
Address
Age
Level
PTA
Parent FB name (REQUIRED)*
HAPPYLAND
Happy Land International School

Zone 7, Balaos, Iponan, Cagayan de Oro City
SCHOOL RULES AND REGULATIONS
The school would like to establish a safe entrance and exit, and crowd
management measures for teachers, students, non-teaching personnel, and school visitors. With this, rules and regulations are set for everyone's strict compli-

ance. Below are the said rules:

All parents are not allowed to stay inside and outside the classroom of his or

Preschool parents are advised to wait in our designated waiting area only. Grade school parents are not permitted to stay or wait in the waiting area. In the waiting area, it's also forbidden to eat, lay down, or make loud noises. In the waiting area, social distancing and wearing of face mask must be ob-

Put your trash in the right bin. Maintain the cleanliness and order in our waiting

Please park your car properly in our parking area. Please avoid double parking. Your children should be dropped off and picked up in the designated area.

I hereby affirm that I read and fully understand the above statement. I'll adhere to and respect the rules and guidelines set forth by the school.
Signature above printed Name

Clear
Date

MonthDayYear
Date
H-elping the next generation through

-fordable school expensesProviding high quality education:Preparing the young ones for a mindset that Y-ields to Christian principles and values

MODIFIED LEARNER ENROLLMENT AND SURVEY FORM SY 2025-2026

D. HOUSEHOLD CAPACITY AND ACCESS TO DISTANCE LEARNING

D1 How man of your household members (including the enrollee) are studying in School Year 2025-2026? Please specify each.

PTA

HAPPYLAND

SCHOOL RULES AND REGULATIONS