Republic of the Philippines

Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF BATAAN
SDO – LIMAY ANNEX
KITANG ELEMENTARY SCHOOL

PUPIL
’S
LRN:

PROFI
NAME: LAST NAME
SANGALANG
FIRST NAME
KARLAINE
MIDDLE NAME
AMBROCIO

LE
ADDDRESS: HOUSE # & STREET
027G ROXAS ST.
BARANGAY
KITANG I
TOWN
LIMAY
BIRTHDAY: NOVEMBER 26, 2011 BIRTHPLACE: BALANGA CITY, BATAAN
AGE: 9 RELIGION: CATHOLIC
WEIGHT: 55 KG HEIGHT: 5’1” BMI:
PARENT’S INFORMATION
FATHER’S NAME AGE
GIANCARLO PERALTA SANGALANG 38
BIRTHDAY EDUCATIONAL ATTAINMENT OCCUPATION
JULY 13, 1982 COLLEGE GRADUATE OFW
MOTHER’S NAME AGE
LORRAINE LEE AMBROCIO SANGALANG 38
BIRTHDAY EDUCATIONAL ATTAINMENT OCCUPATION
AUGUST 23, 1982 COLLEGE GRADUATE TEACHER

NUMBER OF SIBLINGS: GIRL: 0 BOY: 0

CONTACT NUMBER: 09494060122

__________________________________________
PARENT’S/GUARDIAN’S SIGNATURE

School Head: ARLENE M. VALLEJOS

School Address: Roxas St. Kitang I Limay, Bataan
Email: 104630@deped.gov.ph/ 104630kitanges@gmail.com
FB Page: 104630Kitanges