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P. Pelaez Elementary School: Basic Education Enrollment Form

This document is an enrollment form for P. Pelaez Elementary School in Manila. It requests basic information about new students including name, date of birth, address, parents' names, previous school details if transferring, and a certification signed by a parent. The form collects this data to create and update student profiles in the Learner Information System in accordance with the Data Privacy Act of 2012. It is not for sale and must be submitted to the Person-in-Charge/Registrar/Class Adviser using black or blue pen only.

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MA. ASTERIA AGUSTINA CENAL
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55 views1 page

P. Pelaez Elementary School: Basic Education Enrollment Form

This document is an enrollment form for P. Pelaez Elementary School in Manila. It requests basic information about new students including name, date of birth, address, parents' names, previous school details if transferring, and a certification signed by a parent. The form collects this data to create and update student profiles in the Learner Information System in accordance with the Data Privacy Act of 2012. It is not for sale and must be submitted to the Person-in-Charge/Registrar/Class Adviser using black or blue pen only.

Uploaded by

MA. ASTERIA AGUSTINA CENAL
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Division of City Schools

Manila
P. PELAEZ ELEMENTARY SCHOOL
D. Santiago St., Sampaloc, Manila

BASIC EDUCATION ENROLLMENT FORM


THIS FORM IS NOT FOR SALE.
Check the appropriate box only:

School Year: - No LRN With LRN Returning (Balik-Aral)

INSTRUCTIONS: Print legibly all information required in CAPITAL letters. Submit accomplished form to the
Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.

STUDENT INFORMATION
PSA Birth Certificate No.

Learner Reference No. (LRN)

LAST NAME

FIRST NAME

MIDDLE NAME
EXTENSION NAME e.g. Jr., III (if applicable)
DATE OF
BIRTH / / SEX MALE FEMALE AGE
(Month/Day/Year)

Belonging to any Indigenous Peoples (IP)


Community/Indigenous Cultural Community?
No Yes If Yes, please specify:

Mother Tongue

ADDRESS
House Number and Street

Barangay

City/Municipality/Province/Country
Zip Code

PARENT’S/GUARDIAN’S INFORMATION
Father’s Name (Last Name, First Name, Middle Name) Mother’s Maiden Name (Last Name, First Name, Middle Name)

Guardian’s Name (Last Name, First Name, Middle Name)

Telephone Cellphone No.


No.
For Returning Learners (Balik-Aral) and Those Who Shall Transfer/Move In

Last Grade Level Completed Last School Year Completed

School Name School ID

School Address
I hereby certify that the above information given are true and correct to the best of my knowledge and I allow the
Department of Education to use my child’s details to create and/or update his/her learner profile in the Learner Information
System. The information herein shall be treated as confidential in compliance with the Data Privacy Act of 2012.

Signature Over Printed Name of Parent/Guardian Date

For use of DepEd Personnel Only. To be filled up by the Class Adviser.


DATE OF FIRST ATTENDANCE / /
(Month/Day/Year)

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