Pre-Elementary Department Last Name*First Name*Middle Name*If no Middle Name, please write "Not Applicable".Grade Level*NURSERYPRE-KINDERGARTENKINDERGARTENAre you New or Old Student?*New StudentOld StudentLast School Attended*Please selectBuenavista East Elementary SchoolBuenavista West Elementary SchoolBukal Norte Elementary School-MayapyapBukal Norte Elementary School-PuloBukal Sur Elementary SchoolBukal Sur National High SchoolCandelaria Elementary School- Annex 1 and 2Candelaria Elementary School-MainDolores Macasaet National High SchoolDr. Panfilo Castro National High School-AnnexDr. Panfilo Castro National High School-MainGov. Anacleto C. Alcala National High SchoolHeadstart Learning Institute Inc.Kinatihan 1 Elementary SchoolKinatihan 2 Elementary SchoolLusacan National High SchoolLutucan Integrated National High SchoolMalabanban Norte Elemtary SchoolMalabanban Sur Elementary SchoolMangilag Norte Elemtary SchoolMangilag Sur Elementary SchoolManuel L. Quezon Elementary (formerly Chinese School)Manuel S. Enverga University Foundation Candelaria Inc.Masalukot 1 Elementary SchoolMasalukot 2 Elementary SchoolMasalukot 3 Elementary SchoolMasalukot 4 Elementary SchoolMasalukot 5 Elementary SchoolMasin Elementary SchoolMayabobo Elementary SchoolMolino Integrated Montessori School Inc.Newton's Apple School Inc.Pahinga Norte Elementary SchoolPahinga Sur Elementary SchoolPaiisa National High SchoolRecto Memorial National High SchoolSan Andres Elementary SchoolSan Isidro Elementary SchoolSouth East Asia Comprehensive School (SEACOMS)Sta. Catalina National High SchoolSta. Catalina Norte Central Elementary SchoolSta. Catalina Sur Elementary SchoolTayabas Western AcademyThe Lady Mediatrix Institute Inc.Trinity Christian AcademyOthersOthersLast School Attended - Old StudentLast School AttendedEmail address (Student)Email address (Guardian)*Date of Birth*Place of Birth*Gender*Please selectMALEFEMALENationality*Please selectFILIPINOOTHER NATIONALITYOther NationalityReligion*Please selectROMAN CATHOLICIGLESIA NI CRISTOMUSLIMBORN AGAIN CHRISTIANBAPTISTSEVENTH DAY ADVENTISTOTHEROther ReligionDate of Enrolment*Complete Permanent / Home Address*Contact Number of Student (if any)Mother's Maiden Name*OccupationContact Number*Father's Full Name*OccupationContact Number*Guardian's Information*MotherFatherBoth Mother and FatherOther GuardianGuardian's Full Name*Guardian's Contact Number*Guardian's Occupation*Guardian's Relationship to the Student*Student's Information for COVID-19 VaccinationAre you vaccinated?YESNOVaccine Manufacturer*Please selectPFIZER - BIONTECHOXFORD - ASTRAZENECASINOVACSPUTNIK VJANSSENMODERNASINOPHARMSPUTNIK LIGHTNOVAVAXDate of First Dose*Date of Second DoseDid you get your booster vaccination?*YESNOBooster Vaccine Manufacturer*Please selectPFIZER - BIONTECHOXFORD - ASTRAZENECASINOVACSPUTNIK VJANSSENMODERNASINOPHARMSPUTNIK LIGHTNOVAVAXDate of Booster First Dose*Date of Booster Second DoseCurrent Health IssuesAllergies?*YESNOPlease list;MedicationFoodOtherHistory of Anaphylaxis?*YESNOto : Epi-PenYESNOAsthma?*YESNOAsthma Action Plan?YESNOPlease upload a copy of Asthma Action Plan.Diabetes?*YESNOTypeType IType IISeizure Disorder?*YESNOPlease elaborate:Other*YESNOPlease specify:IMPORTANT! This Pre-Enrolment is subject for VALIDATION. It can only be finalized upon submission of the requirements below. List of requirements: Pre Elementary PSA Birth Certification (Photocopy) Progress Report Card Picture 2x2 (3pcs) I understand and agree.Please type the characters before sending.*This helps us prevent spam, thank you.SendThis field should be left blank