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FAMILY INFORMATION SHEET

School Year: 2019-2020

Child code #: 2 Mother code #: 1 Father code #: 1

Child Profile
Child’s name: ___Abantas ___ ________ Jonaisah _________ ____Hadji Edris_____

Last Name Given Name Middle Name

Nickname: _____Jonaisah_______ Grade Level : __________Hadana - I___________

Sex: O male O Female

Birth Date: May 4, 2012

Birth Place: Punud Proper, Marantao, L.D.S

Home Address: Punud Proper, Marantao, L.D.S

CP Number of parent/guardian: __0975-5977-544___

Child’s Health Provider: ___________Parents__________ e.g. Barangay Health Worker, Public


Health Nurse, Private Doctor, Albularyo

_____________________________________________________________________________

Health Profile

CURRIENT HEIGHT: ______122_____ CURRENT WEIGHT: ________23.6_________

Does your child have any food allergy? If yes, please specify below.

N/A

What are the medication that need to be given to your child should a reaction occur? Please note if any special
course of action should be done a reaction occur.
Does your child have any special health or medical condition that must be taken note of? If yes, please explain
the nature of this condition and other important information in relation to this.

N/A

What does your child usually take for : (if none,pls write n/a)

Headeache __________ Allergies __________

Cough & Colds __________ Fever ____________

Asthma __________ Toothache ____________

Others (pls, specify) _________N/A____________________________________________

PERSON TO CONTACT IN CASE OF EMERGENCY : ( Please provide all telephone numbers where you
can be reached during school hours)

NAME RELATION TO CHILD CONTACT NOS.

Johara Macaraya Grandmother N/A

_Alnor M. Hadji Edris__________________________Uncle_____________________N/A__________________

_Alinor M. Hadji Edris_________________________Cousin_____________________N/A_________________

FAMILY INFORMATION

Father’s Name: Bashet M. Abantas

Home Address: Punud Proper, Marantao, L.D.S

Birth Date: December 12, 1979

Mobile No. 0918-2533-063

Occupation: Tracycle Driver

Company Name: N/A

Work Address: N/A

Work Tel. No. N/A

Mother’s Name: Norfaidah P. Hadji Edris


Home Address: Punud Proper, Marantao, L.D.S

Birth Date: May 29, 1978

Mobile No. 0975-5977-544

Occupation: Housewife

Company Name: N/A

Work Address: N/A

Work Tel. No. N/A

Siblings Names Ages School Attended

1. Khalid Abantas 10 Grade-II

2. Abdul Raffy Abantas 3 N/A

3. Khadaraffy Abantas 1 N/A

Other members
Of House Hold NAME RELATION TO CHILD
Johara Macaraya Grandmother

_Alnor M. Hadji Edris _Uncle

_Alinor M. Hadji Edris Cousin

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