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Earlyregv 2

The document is a Basic Education Early Registration Form for learners, requiring personal and family information to be filled out in capital letters. It includes sections for the learner's details, parents' names, and a declaration for data collection compliance with the Data Privacy Act of 2012. The form must be submitted to the appropriate school authority and is not for sale.

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Owen Reyes
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28 views1 page

Earlyregv 2

The document is a Basic Education Early Registration Form for learners, requiring personal and family information to be filled out in capital letters. It includes sections for the learner's details, parents' names, and a declaration for data collection compliance with the Data Privacy Act of 2012. The form must be submitted to the appropriate school authority and is not for sale.

Uploaded by

Owen Reyes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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As of 01/15/2025

BASIC EDUCATION EARLY REGISTRATION FORM


THIS FORM IS NOT FOR SALE

Instructions: Print legibly all information required in CAPITAL letters and check all appropriate boxes. Submit
accomplished form to the Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.
1. School Year Learner Reference No. (LRN), if applicable:
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 __If yes, please
specify:_______________
Is the learner a person with disability (PWD)? ____No ___If yes, please specify:_______________
Current Address:___________________________________________________________________________________
House No. Sitio/Street Barangay Municipality/City Province
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: _____________________
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.

Signature Over Printed Name of Parent/Guardian Date

As of 01/15/2025

BASIC EDUCATION EARLY REGISTRATION FORM


THIS FORM IS NOT FOR SALE

Instructions: Print legibly all information required in CAPITAL letters and check all appropriate boxes. Submit
accomplished form to the Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.
1. School Year Learner Reference No. (LRN), if applicable:
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 __If yes, please
specify:_______________
Is the learner a person with disability (PWD)? ____No ___If yes, please specify:_______________
Current Address:___________________________________________________________________________________
House No. Sitio/Street Barangay Municipality/City Province
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: _____________________
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.

Signature Over Printed Name of Parent/Guardian Date

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