Republic of the Philippines
Department of Education
NATIONAL CAPITAL REGION
SCHOOLS DIVISION OFFICE-MALABON CITY
SIKHAY THEATER AND DANCE GUILD
MEMBERSHIP FORM
The Learner Government Program embodies the ideals, principles, and
practices of participatory democracy. It represents and steers the learners
towards the fulfillment of its goal by promoting their rights and welfare.
As a learner applicant, this Club/Organization Membership Form is a
statement of your best knowledge and understanding in a
club/organization you are joining. Place your
Instruction: Please supply the information requested in the space 2X2 Picture Here
provided.
I. PROFILE
Learner’s Name:
(Surname, Given Name, Middle Name, & Extension Name e.g., Jr., I, II…)
Grade Level:
Gender: Female Date of Birth:
Email Address:
Mobile Number: Landline Number:
____________________________________
Home Address: _______________________________________________________________________________________
II. PARENTAL CONSENT
I,_______________________________________________ as a parent/guardian of
__________________________________________________ will support his/her commitment to the Learner
Government Program (LGP) to the best of my ability.
I am allowing him/her to participate in the programs, projects, and activities of the
__________________________________________.
I agree and understand the commitment of my son/daughter and will support his/her endeavor
to the Learner Government Program (LGP).
_____________________________________________ ______________________________
Name and Signature of the Parent/Guardian Contact Number
III. CERTIFICATION
I am filing this Membership Form of the _____________________________________________ on my own
initiative and free will.
I hereby certify that the facts stated herein are true and correct to the best of my knowledge.
_______________________________________________________
Signature of Learner Applicant over Printed Name
Date:________________________________
Checked by:
MACHELYN M. ROQUE
School Club/Organization Teacher-Adviser
Date: ______________
Ninoy Aquino Elementary School Comp. Maya-maya St.,
Longos, Malabon City
((02) 83751995; 83748708; 83748729
malabon.city@deped.gov.ph http://depedmalaboncity.ph
