Personal Information Sheet

School Year

Grade:

Name:

(Last Name)

(First Name)

(Name Extn.)

(Middle Name) ^*N/A

Nickname:

Sex: ^*

Citizenship/s: ^* /

Birthdate: ^*(mm/dd/yyyy)

Age:(as of October 31)

Birthplace (City): ^*

Religion: ^*

Present Address ( PHL ):

(Province ^*)

(City ^*)

(Barangay ^*)

(Street ^*)

Residential Address Abroad(if applicable):

MOTHER

Maiden Name ^*:

Citizenship ^*:

Occupation ^*:

Business Address ^*:

Contact No. ^*:

Email Address ^*:

FATHER

Name ^*:

Citizenship ^*:

Occupation ^*:

Business Address ^*:

Contact No. ^*:

Email Address ^*:

Official Guardian ^*:

Relationship ^*:

Contact No. ^*:

Academic Information Sheet

LRN ^*:

ESC No.:(if applicable)

Last School Attended ^*:

Last School Year Attended:

School Address:

Mother Tongue: ^*

Do you want to participate in face-to-face classes?:

Yes No

Signature over Printed Name of Parent / Guardian

Medical Information Sheet

IN CASE OF EMERGENCY

Name ^*:

Relation ^*:

Contact No. ^*:

Address ^*:

Family Physician's Name ^*:

Family Dentist's Name ^*:

Are the parents living together:

Yes No

Allergy:

Allergic Reaction:

Please check if the child has/had these diseases:

Surgery undergone:

Date:

Does your child have existing illnesses/comorbidities ^*?

Yes No

Any pertinent medical condition/s:

Vaccines the child has received ^*:

BCG OPV DPT MMR Hepatitis B Tetanus Toxoid COVID-19

Has your child consulted a mental health professional in the past ^*?

Yes No

If the child is asthmatic, please leave stock/s of medicine in the clinic.

I certify that the above information is correct. I am aware that inaccuracies may endanger the child's health.

Enrollment Agreement and Consent

We acknowledge that we have thoroughly read and understood this Enrollment and Consent Form, and we agree to be bound by and comply with the guidelines stipulated therein. We understand that PISD can modify or amend school rules at any time as it may deem reasonable, and we agree to abide by them.

We affirm our commitment to support the school’s vision and mission as a Christian, Filipino, International School in consonance to its Philosophy, Goals and Core Values.

Signature over Printed Name of Parent / Guardian