Gmail Address Used for Registration

BASIC EDUCATIONAL EARLY REGISTRATION FORM

1. School Year

Learner Reference No. (LRN)

2. Grade Level to Enroll

3. Learner's Personal Information

Learner's Name:

Last Name

Given Name

Middle Name

Extn. Name (if any)

Birthdate (mm/dd/yyyy):

Age:

Sex:

Male Female

Religion:

Belonging to any Indigenous Peoples (IP) Community/Indigenous Cultural Community?

No Yes

If yes, please specify:

Is the learner a person with disability (PWD)?

No Yes

If yes, please specify:

Current Address

Barangay

Municipality/City

Province

Parent/Guardian Information

Father's Name:

Last Name

Given Name

Middle Name

Extn. Name (if any)

Mother's Maiden Name:

Last Name

Given Name

Middle Name

Extn. Name (if any)

Legal Guardian's Name:

Last Name

Given Name

Middle Name

Extn. Name (if any)

Contact Number:

Type of Enrollee:

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 for the early registration data collection. The information herein shall be treated as confidential in compliance with the **Data Privacy Act of 2012.**

Printed Name

Date

Upload E-Signature (Image):

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BASIC EDUCATIONAL EARLY REGISTRATION FORM

3. Learner's Personal Information

Parent/Guardian Information

New Entrant - Kinder Required Documents

Transferee Required Documents

Returnee Required Documents

3. Learner's Personal Information

Parent/Guardian Information

New Entrant - Kinder Required Documents

Transferee Required Documents

Returnee Required Documents

Draw E-Signature