Republic of the Philippines

Document Code: SDO-QF-CID -00XX

Department of Education
Region III – Central Luzon
Revision: 00
SCHOOLS DIVISION OF PAMPANGA
EM E N TA R
High School Blvd. Brgy. Lourdes, City of San Fernando EL
Effectively date:

Y
T
M A SA M A

SC
SM
Name of Office:

HOOL
EARLY REGISTRATION MASAMAT ELEMENTARY

M
X IC

T
STR

IC
E
O SO
UTH DI
S.Y. 2020-2021 SCHOOL

List of Incoming Pupils 2020-2021

________KINDERGARTEN_________
Kindergarten/Grade/Year Level

NAME SEX AGE BIRTHDATE Address CATEGORY OF C/Y Remarks

WITH
DISABILITY** (for
Children and
Youth with
Disabilities only)

Remarks*
1. For Grade 1 Registrants: Has attended/not attended Kindergarten class
2. For ALS: Information whether the child/youth prefers to learn through the ADM = alternative
delivery mode (MISOSA, e-IMPACT, DORP) or ALS = alternative learning system
Category of C/Y with disability ** Visual Impairment, Hearing Impairment, Intellectual Disability,
Learning Disability, Speech/Language Impairment, Serious Emotional Disturbance, Autism
Orthopedic Impairment, Special Health Problem, Multiple Disabilities

List of Incoming Pupils 2020-2021

__________Grade One_____________
 Republic of the Philippines
Document Code: SDO-QF-CID -00XX
Department of Education
Region III – Central Luzon
Revision: 00
SCHOOLS DIVISION OF PAMPANGA
EM E N TA R
High School Blvd. Brgy. Lourdes, City of San Fernando EL
Effectively date:

Y
T
M A SA M A

SC
SM
Name of Office:

HOOL
EARLY REGISTRATION MASAMAT ELEMENTARY

M
X IC

T
STR

IC
E
O SO
UTH DI
S.Y. 2020-2021 SCHOOL

Kindergarten/Grade/Year Level

NAME SEX AGE BIRTHDATE Address CATEGORY OF C/Y Remarks

WITH
DISABILITY** (for
Children and
Youth with
Disabilities only)

Remarks*
1. For Grade 1 Registrants: Has attended/not attended Kindergarten class
2. For ALS: Information whether the child/youth prefers to learn through the ADM = alternative
delivery mode (MISOSA, e-IMPACT, DORP) or ALS = alternative learning system
Category of C/Y with disability ** Visual Impairment, Hearing Impairment, Intellectual Disability,
Learning Disability, Speech/Language Impairment, Serious Emotional Disturbance, Autism
Orthopedic Impairment, Special Health Problem, Multiple Disabilities