Little child Jesus Christian Academy

Cabiao, Nueva Ecija, Inc.

Polilio, Cabiao, Nueva Ecija
Government Recognition Nos. E- 077 s 2007 PS/E-011 s2011 GS/ S-009 s.2015
Contact Nos.: 09171260144/0925 500 1987/0916-533-4050
GUIDANCE AND TESTING OFFICE
PRE-SCHOOL APPLICATION FORM
Level Applied for: Applicant ID:
NAME OF APPLICANT:
(Name in Birth Certificate) SURNAME GIVEN NAME MIDDLE NAME (M.I. used)
Home Address (No./Street/ Brgy./City/Province Nickname:
Gender:
Contact No.: Mobile No.: Email:
Birth: Month_____ Day_____ Year_____ Place of Birth:
Nationality: Religion: Baptized: ___Yes ___No
Child living with: Primary Language spoken at home:
What languages can your child understand?:
Did your child have any previous schooling? ___ Yes ___ No If yes, how many years? _______________
What school/schools?: Level / Levels:
Number of sisters: Number of brothers:
Name of Sister(s)/Brother(s) Date of Birth School/Department Grade/Year

Father's Full Name: Mother's Full Name:

Date of Birth: Date of Birth:
Educ. Attainment / Degree: Educ. Attainment / Degree:
Occupation: Occupation:
Business / Office Name: Business / Office Name:
Business / Office Address: Business / Office Address:
Business / Office Landline: Business / Office Landline:
Email Address: Email Address:
Please check the number you will register for LCJCA SMS advisories:
_____ Mobile number: _____ Mobile number:
Marital Status:
____Single Parent ____Separated ___Spouse Abroad ___ Others, please specify:
____ Married ____ Annulled ___Widowed ____________________
Other than parents, alternative persons to contact when necessary:
Name: Relation to Applicant: Telephone Number:

How did you find out about LCJCA:

_____ Referral _____ Walk-in _____ Social Media
ACKNOWLEDGEMENT FORM
By signing below, I certify all information is true and correct to the best of my knowledge.

______________________________ _______________________________
Father’s signature over printed name Mother’s signature over printed name

DATE