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Student Registration
Immaculate Conception School of Naic INC.
1
Basic Info
2
Family
3
Health
4
Education
5
Future Plans
Plans
Complete all sections to submit your registration
Basic Information
First Name
*
Middle Name
Last Name
*
Nickname
Gender
*
Select Gender
Male
Female
Birth Date
Department
*
Select Department
Kinder-Nursery Department
Elementary Department
High School Department
Senior High School Department
Year Level
*
Select Year
Nursery
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Level/Section
Student Photo
Optional. Formats: JPG, PNG, GIF
Contact Information
Birth Place
Contact Number
Religion
Nationality
Complete Address
Family Information
Father's Information
Father's Name
Father's Age
Father's Occupation
Father's Education
Father's Employer
Father's Place of Work
Father's Contact
Mother's Information
Mother's Name
Mother's Age
Mother's Occupation
Mother's Education
Mother's Contact
Mother's Employer
Mother's Place of Work
Guardian Information (if applicable)
Guardian's Name
Guardian's Age
Guardian's Occupation
Guardian's Contact
Guardian's Education
Family Composition (Living at Home)
Brothers & Sisters
(including yourself)
Age
Civil Status
School Attending
Occupation
Physical & Health Information
Height
Weight
Blood Type
Select Blood Type
A+
A-
B+
B-
AB+
AB-
O+
O-
Allergies
Ever been hospitalized?
Select
Yes
No
Hospitalization Details
Major Illness
Select
None
Yes
Illness Details
IV. HEALTH HISTORY
Absent due to illness:
Yes
No
If yes, specify illness:
Ever been hospitalized:
Yes
No
If yes, specify illness:
Educational Background
Elementary School
Year Graduated
Senior High School
Year Graduated
Nature of Schooling
Select
Public
Private
Reason for Studying Here
Study Habits & Future Plans
Most Liked Subject
Least Liked Subject
Future Course/Career Goal
Who influenced this choice?
Reason for course choice
Person You Like Most
Person Who Influences You Most
Submit Registration
Submit Registration
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