ONLINE REGISTRATION

GRADE SCHOOL / JUNIOR HIGH SCHOOL

* Required

Email address *
Your email

LAST NAME *
(Last Name of Student)

Your answer

FIRST NAME *
(Name of Student)

Your answer

MIDDLE NAME *
(Middle Name of Student)

Your answer

PHONE NUMBER *

Your answer

PLACE OF BIRTH *

Your answer

DATE OF BIRTH *
Date

GENDER *
Female
Male

COMPLETE ADDRESS *
Your answer

PARENT / GUARDIAN *

Your answer

PHONE NUMBER *

Your answer

GRADE LEVEL *
Choose

STUDENT STATUS *
Old Student
New Student
Transferee

LRN (LEARNERS REFERENCE NUMBER)

(OPTIONAL)

Your answer

SCHOOL LAST ATTENDED *

Your answer

SCHOOL YEAR *
(Last Attended)

Your answer

A copy of your responses will be emailed to the address you provided.

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