Republic of the Philippines

Department of Education
Region 4A CALABARZON
SCHOOLS DIVISION OF CALAMBA CITY
CLUSTER 4
REAL ELEMENTARY SCHOOL
School Year 2022 – 2023

ANECDOTAL RECORD

Name: __________________________________________________

Grade/Section: FOUR-EINSTEIN Class Adviser: MRS. AURORA CLARE L. MENEZ

Address: _________________________________________________________________________________
Age: __________ Birthdate: _____________________ Birth Place: ________________________________
Name of Father: _________________________________________ Age: _______ Occupation: __________________

Name of Mother: ________________________________________ Age: _______ Occupation: __________________

Number of Siblings: _______________

Name of Guardian: _______________________________________ Age: _______ Occupation: __________________

Subject/s found easy: _______________________________ Subject/s found difficult: __________________________

Early Diseases: _________________________________ Serious Accident/s: __________________________________

Notes/Remarks:

DATE:

____________________________________ _________________________________________

Signature over Printed name Signature over Printed name

PARENT/GUARDIAN LEARNER

Address:Brgy. Real, Calamba City

Telephone No. (049) 545-0901
EmailAddress: 109823@gmail.com