Republic of the Philippines

Department of Education
National Capital Region
Division of Pasig City

2 X 2
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PASIG CITY SCIENCE HIGH SCHOOL

ENROLMENT FORM
I.

Date: ________________

STUDENT PERSONAL INFORMATION

Student ID # __________

Learners Reference Number (LRN): __________________________

Last Name: _______________________ First Name: _________________________ Middle Name: _______________

Ext. Name: __________

Gender:

Male

Female

Admission for School Year: 2015-2016

Date of Birth _______________ Age: _____ General Weighted Average: _______ Email address: _______________
Elementary School Attended: ____________________________
Landline: ______________
Home Address:

Public

Private Religion: _____________

Mobile (Main) : __________________, __________________, __________________

House no. _____ Street: ___________________________ Subdivision: _______________________

Barangay: ________________

City:

PASIG

Honors:
Valedictorian
Salutatorian
Others(Specify) ______________________________________
Talents: ________________________________________________________________________________________
Hobbies: ________________________________________________________________________________________
Signature : _____________________________
II.

Fathers Information

Last Name: __________________ First Name: ___________________ Middle Name: __________________ Ext. ____
Educational Attainment: __________________________ Telephone: _______________ Mobile:_________________
Occupation: ____________________________ Position: ______________________ Email address: ______________
Company: ___________________________________ Address: ____________________________________________
Signature: _____________________________
III

Mothers Information (Maiden Name)

Last Name: ____________________ First Name: _________________________ Middle Name: _________________

Educational Attainment: __________________________ Telephone: _______________ Mobile:_________________
Occupation: ____________________________ Position: ______________________ Email address: ______________
Company: ___________________________________ Address: ____________________________________________
Signature: _____________________________

IV

Guardians Information (If Applicable)

Last Name: ____________________ First Name: _________________________ Middle Name: __________________

Educational Attainment: __________________________ Telephone: _______________ Mobile:_________________
Occupation: ____________________________ Position: ______________________ Email address: ______________
Company: ___________________________________ Address: ____________________________________________
Signature: _____________________________

FOR SCHOOL USE ONLY

Form 138 (Original)
Form 137A (For Grade 7 only)
Good Moral (For Grade 7 only)

Assisted by:
_________________________
Gloria F. David
Registrar

Elective: _________________________________
Grade & Section: __________________________
Date Enrolled: ____________________________

Approved by:

JAY MATHIAS A. ARELLANO, PTRP, RN, MAEd

PRINCIPAL

AGREEMENT
I hereby solemnly swear/affirm, under penalty of expulsion, that the answers given in this Student
Enrolment Form are true and correct to the best of my knowledge.
Further, I solemnly swear that I will strictly and faithfully follow the rules, regulations and policies of this
school. To this end, I promise:
A. 1. To attend all my classes regularly and punctually.
2. To come to school on time regardless of the distance from where I live:
3. To attend the Flag Ceremony at 6:30 a.m. every Monday and promptly come to school at 7:00 a.m.
from Tuesday to Friday.
4. To wear the prescribed school and P.E. Uniforms.
5. To obey the prescribed haircut for boys and girls.
B. 1. Not to smoke, drink alcoholic substances and use prohibited drugs.
2. Not to come to school when I am under the influence of alcohol or prohibited drugs nor
bring alcohol or prohibited drugs inside the school premises.
3. Not to carry dangerous weapons, pornographic materials and explosive inside the school
premises.
4. Not to join unauthorized organizations, gangs, fraternities/sororities, cults and others.
5. Not to forge and/or tamper school official records and documents and the like.
6. Safeguard school properties and facilities and promise to pay the corresponding amount
for property and/or facility lost/damaged by me.

________________________________
Students Signature Over Printed Name

1. I/We have read the basic rules and regulations of the school and pledge to cooperate with the
school in helping our child abide by the guidelines.
2. Specifically, I/we shall attend meetings, assemblies and other school activities called for by the
school administration.
3. I/We shall also support the school in any undertaking when called for.
4. I/We shall make the necessary appointments prior to meeting with school administrator, faculty
and/or staff.
5. Further, I/we pledge to adhere to the schools existing policies of the ParentsTeachers Association
(PTA).

______________________________
Parents /Legal Guardians Signature
Over Printed Name