CHILD PROFILE

(For Pupils with No Birth Certificate upon Entrance in Grade 1)

CHILD
1 Name
________________ ______________ ____________
(First Name) (Middle Name) (Last Name)
2 Sex Male Female

3 Date of Birth
4 Place of Birth
5 Type of Birth Single Twin Triplet

6 Citizenship Filipino Foreigner

7 Birth Order 1st 2nd 3rd last others

(specify)
8 Attendant Physician Nurse Midwife Hilot

MOTHER
1 Maiden Name
2 Citizenship
3 Religion
4 Number of Children Born
5 Number of Children Still
Living
6 Occupation
7 Age at time of Birth
8 Residence
FATHER
1 Name
2 Citizenship
3 Religion
4 Occupation
5 Age at time of Birth
6 Date of Marriage
7 Place of Marriage

AFFIDAVIT OF ACKNOWLEDGEMENT

We/I _____________________________ and ____________________________________,

parent/s of the child mentioned in this child profile do hereby solemnly swear that the
information contained herein are true and correct to the best of our/ my knowledge and
belief.
___________________________________
Signature over Printed Name