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BASIC EDUCATION EARLY REGISTRATION FORM
THIS FORM IS NOT FOR SALE
1. Academic & LRN Info
School Year:
Learner Reference No. (LRN) - 12 Digits:
2. Learner's Personal Information
Last Name:
Given Name:
Middle Name:
Extn. Name (Jr, Sr, etc.):
Email Address (Required Gmail):
Birthdate:
Age:
Sex:
Male
Female
Religion:
Belonging to any Indigenous Peoples (IP) Community?
No
Yes, please specify:
Is the learner a person with disability (PWD)?
No
Yes, please specify:
Current Address:
House No. (Optional)
Sitio/Street
Barangay
Municipality/City
Province
3. Parents / Guardian Info
Father's Name (Optional):
Mother's Maiden Name (Optional):
Legal Guardian's Name:
Contact Number (Optional):
Certification:
I hereby certify that the above information given are true and correct to the best of my knowledge and I allow the Department of Education to use my child's details for the early registration data collection. The information herein shall be treated as confidential in compliance with the Data Privacy Act of 2012.
Submit Registration Form