KAPITBAHAYAN ELEMENTARY SCHOOL

School I.D. 136859

Navotas I

Anecdotal Record Form

A. PAGKAKAKILANLAN:

PANGALAN: _________Sven Kayle Rivera Sayat_____________

LRN (Learners Registration Number): ___511505150002_________
Age/Edad: __12__ Height/ Taas: _____ Weight/ Timbang: ___49 kg___
Birthdate / Kapanganakan: __AUGUST 20, 2011_______________
Birthplace/ Lugar kung saan pinanganak: __Sampaloc, Manila________
Religion/ Relihiyong Kinaaaniban: _Roman Catholic________________

Tahanan: ___Blk 2 Lot 16 Phase 1C, Brgy. NBBS-Kaunlaran, Navotas

Pangalang ng Magulang: Hanapbuhay:

Tatay: ___Mark Steve Sayat__________________ _____Driver______________
Nanay: __Khristine Kate Sayat_________________ ______Sales Staff____________
(Pangalan sa Pagkadalaga)

Kasali o meyembro sa (4P’s) Pangtawid Pamilya? __Hindi po_____

Mayroon bang “scholarship”? ___Wala po____
Kung Oo, isulat kung sino o ano ang nagbigay? ______________________________
Ilang magkakapatid? _____2________ Pang-ilan sa Magkakapatid? __Panganay_____

Sino ang maaaring tawagan kung may “emergency”? _Khristine Kate Sayat__________
Anong numero ang maaaring tawagan? (Contact No.) __09430117170______________

B. PANG-AKADEMIKO at PANGKAASALAN:
1. Natatanging Talento/ Kakayahan? Pagkapanalo: (Special Talent / Skills / Winnings)

Mayroon Wala Antas ng Pagkapanalo

1. Pagkanta /
2. Pagsayaw /
3. Pagguhit o Pagpinta /
4. Pag-arte /
5. Pagtatalumpati o Balagtasan /
6. Palakasan /
7. Atletiks /
8. Leadership /
9. at iba pa (pakisulat kung ano)

2. Natanggap na Pagkilala: (Academic Recognitions obtain in)

Grade I - _____________________________________
Grade II - ____________________________________
Grade III - ____________________________________
Grade IV - ____________________________________
Grade V - ___With High Honor, Best in English________
Grade VI - ____________________________________
 (Cases of Significant Misdemeanor/s)
PETSA PAGLABAG AKSYON PUNA LAGDA NG
(Date) (Case/ Incidence) (Intervention) (Remarks) MAGULANG
(Parents Signature)

Prepared by:

MRS. LILIBETH P. GARZON

Teacher-in-Charge

Noted:

FLORETTA M. QUIJANO, ED. D

Principal IV