Republic of the Philippines

Department of Education
Region VI – Western Visayas
Division of Bacolod City
PAGLAUM VILLAGE ELEMENTARY SCHOOL
Paglaum Village, Brgy. Mansilingan, Bacolod City

HOME VISITATION FORM

Name of Student:: _________________________ LRN: ________________ Grade/Section : _______

Address : ______________________ Birthday: ___________________Gender: FEMALE Age: ____

Name of Father: ____________ Contact Number: ____________

Name of Mother: _____________________________ Contact Number: ______________

REASON FOR HOME VISITATION:

REMARKS/AGREEMENT:

_________________________________ ________________________________

PARENT’S SIGNATURE OVER PRINTED NAME STUDENT’S SIGNATURE OVER PRINTED NAME

Prepared by:

_____________________
Teacher

Paglaum Village Elementary School

Paglaum Village, Brgy. Mansilingan, Bacolod City
Tel. No.: 707-2523;
E-Mail address: paglaumvillage_es@yahoo.com/117473.bacolod@deped.gov.ph
 Republic of the Philippines
Department of Education
Region VI – Western Visayas
Division of Bacolod City
PAGLAUM VILLAGE ELEMENTARY SCHOOL
Paglaum Village, Brgy. Mansilingan, Bacolod City

EARLY REGISTRATION
S.Y. 2022-2023
GRADE 1

Paglaum Village Elementary School

Paglaum Village, Brgy. Mansilingan, Bacolod City
Tel. No.: 707-2523;
E-Mail address: paglaumvillage_es@yahoo.com/117473.bacolod@deped.gov.ph