As of 05/15/2025
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 - (For Kindergarten Enrollees) Learner Reference No. (LRN), if applicable:
2. Grade Level to Enroll: ____ Does the learner have attended any
(For SHS)Track &Strand:__________ Early Learning Program? If yes, specify:_______________
3.Learner’s Personal Information
Learner’s Name:____________________________________________________________________________________
(Last Name) (First Name) (Middle Name) (Extn. Name, if any)
Birthdate (mm/dd/yyyy): Age: ____ Sex: Male Female Religion:_____________
Belonging to any Indigenous Peoples (IP) /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) (First Name) (Middle Name) (Extn. Name, if any)
Mother’s Maiden Name:______________________________________________________________________________
(Last Name) (First Name) (Middle Name) (Extn. Name, if any)
Legal Guardian’s Name:_____________________________________________________________________________
(Last Name) (First 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 05/15/2025
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 - (For Kindergarten Enrollees) Learner Reference No. (LRN), if applicable:
2. Grade Level to Enroll: ____ Does the learner have attended any
(For SHS) Track &Strand:__________ Early Learning Program? If yes, specify:_______________
3.Learner’s Personal Information
Learner’s Name:____________________________________________________________________________________
(Last Name) (First Name) (Middle Name) (Extn. Name, if any)
Birthdate (mm/dd/yyyy): Age: ____ Sex: Male Female Religion:_____________
Belonging to any Indigenous Peoples (IP) /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) (First Name) (Middle Name) (Extn. Name, if any)
Mother’s Maiden Name:______________________________________________________________________________
(Last Name) (First Name) (Middle Name) (Extn. Name, if any)
Legal Guardian’s Name:_____________________________________________________________________________
(Last Name) (First 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
