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THE UNITED METHODIST CHURCH

VALUES SCHOOL, INC.


Palamis, Alaminos City, Pangasinan

PUPIL’S BIOGRAPHICAL FORM

No. _________ School Year: ________________ Classification: ___________________________

PERSONAL INFORMATION:

Name: _______________________________________________________________________________
(Name) (Middle Name) (Last Name)

Nickname: ________________________ Age: __________ Gender: ( ) Male ( ) Female


Date of Birth: ___________________________ Birth Place:__________________________________
Home Address: ________________________________________________________________________
Name of Church Attending at Present: __________________________ Tel. No. __________________
Name of School Previously Attended: __________________________ Level: ____________________
Address of School Previously Attended: ____________________________________________________

PARENT’S INFORMATION:

Father: _______________________________ Mother: ___________________________________


Date of Birth: __________________________ Date of Birth: ______________________________
Nationality: ___________________________ Nationality: _______________________________
Educ’l. Attainment: _____________________ Educ’l. Attainment: _________________________
Occupation: ___________________________ Occupation: _______________________________
Place of Work: _________________________ Place of Work: _____________________________
Tel. No. ______________________________ Tel. No. ___________________________________

OTHER CHILDREN IN THE FAMILY:

Name Date of Birth Gender Year enrolled


in UMC-VSI
__________________________________ __________ ______ ___________
__________________________________ __________ ______ ___________
__________________________________ __________ ______ ___________
__________________________________ __________ ______ ___________
__________________________________ __________ ______ ___________

PERSONS TO BE INFORMED IN CASE OF EMERGENCY:

Name: _______________________________ Name: _____________________________________


Address: _____________________________ Address: ___________________________________
_____________________________________ ___________________________________________
Tel. No.: _____________________________ Tel. No. ____________________________________
Relation to Child: ______________________ Relation to Child: ____________________________
Tel. No. ______________________________ Tel. No. ____________________________________

Date Enrolled: _________________________

_____________________________________ _____________________________________
(Parent’s Signature over Printed Name) STAFF IN – CHARGE

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