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Learner Reference Number (LRN)

Enrollment Type

Grade Level

Strand

Last Name

First Name

Middle Name

Extension Name

House No. / Street / Purok

Barangay

Municipality

Province

Birthplace

Age

Date of Birth

Gender

Contact Number

Religion

Nationality

Allergies (type NONE if no allergies)

Last School Attended

Mother's Name

Mother's Contact Number

Mother's Birthday

Father's Name

Father's Contact Number

Father's Birthday

Guardian's Name

Guardian's Contact Number

Guardian's Birthday

Mother's / Guardian's Name

Mother's / Guardian's Birthday

Father's / Guardian's Name

Father's / Guardian's Birthday

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