Alcantara Christian School, Inc.

Registration
Poblacion, Alcantara, Romblon
SLIP
Class: __________
Direction: Please write in CAPITAL LETTERS

Child’s information
Please attach your child’s Birth Certificate.

NAME: ____________________________________________________________________________________________________________
(Last) (First) (Middle)

GENDER: _____Male _____Female BIRTHDATE: (mm/dd/yyyy) _________________ AGE: ______

Right Handed: ______ Left Handed: ______ Both: _______ Not yet established: ______

Guardian’s information CONTACT NUMBER: _______________________________

MOTHER’S MAIDEN NAME: _______________________________________________________________________________________

(Last) (First) (Middle)
MOTHER’S OCUPATION: _____________________________ MOTHER’S AGE: _____
MOTHER’S EDUCATIONAL ATTAINMENT: _______________________________________
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FATHER’S NAME: _________________________________________________________________________________________________
(Last) (First) (Middle)
FATHER’S OCUPATION: _____________________________ FATHER’S AGE: _____
FATHER’S EDUCATIONAL ATTAINMENT: _______________________________________
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GUARDIAN’S NAME: _______________________________________________________________________________________________

(Last) (First) (Middle)

RELATIONSHIP OF CHILD AND THE GUARDIAN: ___________________________

CHILD’S NUMBER OF SIBLINGS: _______ CHILD’S BIRTH ORDER: ________ (1st, 2nd, 3rd, etc.)

CURRENT RESIDENCE/ADDRESS: _________________________________________________________________________________

RELIGION: __________________________________

Health information
Physically Fit: _____
Under Observation: _____
With Illness: _____ What Illness? ______________________
Without Idea: _____

Enrolled by : ____________________________________
Signature Over Printed Name

Admitted by: ____________________________________

Signature Over Printed Name

Date: ____________________________________