Early Registration Form Phone STUDENT INFORMATION School Year * Grade Level to Enroll * Grade 11 Grade 12 LRN * No LRN With LRN Returning (Balik-aral) PSA Birth Certificate no. (if available upon registration) LAST NAME * FIRST NAME * MIDDLE NAME * EXTENSION NAME e.g. Jr., III (if applicable) * DATE OF BIRTH * SEX * MALE FEMALE AGE * Belonging to any Indigenous Peoples (IP) Community/Indigenous Cultural Community? * Yes No Mother Tongue * ADDRESS House Number and Street / Subd. / Village * 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) * Cellphone No * Telephone No. (Optional) For Learners in Senior High School Semester * 1st Sem 2nd Sem Track * Academic TVL Arts & Design Sports Strand (If any) * ABM GAS STEM H.E. ICT Sports Arts and Design Preferred Distance Learning Modality Choose a Preferred Distance Learning Modality * Modular (Print) Modular (Digital) Online Educational TV Radio-based instruction Homeschooling Blended
