Republic of the Republic

Department of Education
Region XI
Division of Davao Occidental

ALBERTO OLARTE SR. NATIONAL HIGH SCHOOL

Mabila, Sarangani, Davao Occidental

JUNIOR HIGH SCHOOL REGISTRATION FORM

a. Name :__________________________________________Grade :___________LRN #:______________

Last First MI.

Birthdate: _________________Age:__________ Sex: _________ Ethnicity: _______________

Address: _______________________________________ Contact Number: _______________
If new enrollee graduated from: __________________________________________________

b. Father’s name :__________________________________ Mother’s name :______________________

c. Contact No:______________________ Source of Income :___________________ Religion :________
d. Student’s Profile :_________________
i. Regular :__________ Parental Support ______________
ii. Repeater :_________ 4 P’s Member :_________________
iii. Balik Aral :__________ Self Supporting :_______________
iv. Transferee : ____Yes _____No: If Yes Previous School :________________________
e. READING STATUS :_______ Credentials submitted :_
a. Independent :__________ Form 137 :_____________________
b. Instructional :__________ Birth Cert ( PSA):________________
c. Frustration :____________ Good Moral :___________________
d. Non Reader :___________ Others :________________________

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NUTRITIONAL STATUS
(BMI)

Height __________ Severely Wasted: ____________ Overweight: ______________

Weight: __________ Wasted: ________ Normal: ____________ Obese: __________

HEDDY N. ARENDAIN
School Clinic In-Charge
Recommendation:

___________________________________________________________________________________________

______________________ MOTH A. SAPAC

Prefect of Discipline EMIS- In-charge

Approved: DENIEMEL B. PADILLON

School Head