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    Basic Education Enrollment Form - Revised 3 2023

    Uploaded by

    Francis
    This document is an enrollment form for Baguio City National Science High School for the 2023-2024 school year. It requests basic information about the learner including name, birthdate, address, parents'/guardians' details, previous school, and preferred distance learning modality. The parent/guardian certifies the information is true and correct and allows the Department of Education to use the details to create or update the learner's profile in accordance with data privacy laws.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Basic Education Enrollment Form - Revised 3 2023

    Uploaded by

    Francis
    77 views1 page
    This document is an enrollment form for Baguio City National Science High School for the 2023-2024 school year. It requests basic information about the learner including name, birthdate, address, parents'/guardians' details, previous school, and preferred distance learning modality. The parent/guardian certifies the information is true and correct and allows the Department of Education to use the details to create or update the learner's profile in accordance with data privacy laws.

    Original Description:

    Baguio City National Science High School enrollment form

    Original Title

    Basic-Education-Enrollment-Form_Revised-3-2023

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    This document is an enrollment form for Baguio City National Science High School for the 2023-2024 school year. It requests basic information about the learner including name, birthdate, address, parents'/guardians' details, previous school, and preferred distance learning modality. The parent/guardian certifies the information is true and correct and allows the Department of Education to use the details to create or update the learner's profile in accordance with data privacy laws.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    77 views1 page

    Basic Education Enrollment Form - Revised 3 2023

    Uploaded by

    Francis
    This document is an enrollment form for Baguio City National Science High School for the 2023-2024 school year. It requests basic information about the learner including name, birthdate, address, parents'/guardians' details, previous school, and preferred distance learning modality. The parent/guardian certifies the information is true and correct and allows the Department of Education to use the details to create or update the learner's profile in accordance with data privacy laws.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ANNEX 1

    Revised as of 03/27/2023
    Baguio City National Science High School
    Purok 12, Irisan, Baguio City Please Attach 2x2 ID
    Picture here. This Picture
    BASIC EDUCATION ENROLLMENT FORM will be used in the Learner’s
    Identification Card
    SY 2023-2024

    School Year 2 0 2 3 2 0 2 4 Check the appropriate box only

    Grade level to Enroll: 1. With LRN? □ Yes □ No 2. Returning (Balik-Aral) □ Yes □ No


    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.

    LEARNER INFORMATION

    PSA Birth Certificate No. (if available upon registration) _________________________________________________ Learner Reference No. (LRN)
    Place of Birth (Municipality/City)
    Last Name Birthdate (mm/dd/yyyy)
    / /

    First Name Sex □ Male Age Mother Tongue

    □ Female
    Belonging to any Indigenous Peoples (IP) Community/Indigenous Cultural Community
    Middle Name
    □ Yes □ No If Yes, please specify:

    Extension Name e.g. Jr., III (if applicable)


    Is your family a beneficiary of 4Ps? □ Yes □ No
    If Yes, write the 4Ps Household ID Number below

    Is the child a Learner with Disability? □ Yes □No


    If Yes, specify the type of disability:
    Visual Impairment □ HearingImpairment □ Learning Disability □ Intellectual Disability
    a. blind □ Autism Spectrum Disorder □ Emotional- Behavioral Disorder □ Orthopedic/Physical Handicap
    b. low vision □ Speech/Language Disorder □ Cerebral Palsy □ Special Health Problem/ Chronic Disease
    □ Multiple Disorder Others: ______________________ □ a. Cancer
    Current Address
    House No. Sitio/Street Name Barangay

    Municipality/City Province Country Zip Code

    Permanent Address Same with your Current Address? □ Yes □ No


    House No./Street Street Name Barangay

    Municipality/City Province Country Zip Code

    PARENT'S/GUARDIAN'S INFORMATION

    Father’s Name
    Last Name First Name Middle Name Contact Number

    Mother’s Maiden Name


    Last Name First Name Middle Name Contact Number

    Legal Guardian’s Name


    Last Name First Name Middle Name Contact Number

    For Returning Learner (Balik-Aral) and Those Who will Transfer/Move In


    Last Grade Level Completed Last School Year Completed _______________________________________

    Last School Attended School ID

    For Learners in Senior High School

    Semester □1 st
    □2 nd
    Track __
    Strand
    If school will implement other distance learning modalities aside from face-to-face instruction, what would you prefer for your child?
    Choose all that apply:

    □ Modular (Print)
    □
    Online □
    Radio-Based Instruction □ Blended

    □ Modular (Digital) □ Educational Television □ Homeschooling


    I hereby certify that the above information given are true and correct o 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

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