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REGISTRATION FORM

Instruction: This form to be filled up by the parents/guardian of the child upon enrollment to the
Child Development Center. This will be kept by the Child Development Teacher in the portfolio of the
child.

Name of Child: ______________________________________ Sex: M: _____ F: _____

Address: ___________________________________________ Birthday: _______________

Guardian: __________________________________________ Relationship: _________________

Registered: dd Yes No Age: ___________

Guardian Information: E-mail Address: ________________________

Mother:

Name: _____________________________________________ Occupation: ____________________

Address: ____________________________________________________________________________

Contact Number: Home: ____________________________ Work: __________________________

Father:

Name: _____________________________________________ Occupation: ____________________

Address: ____________________________________________________________________________

Contact Number: Home: ____________________________ Work: __________________________

IN CASE OF EMERGENCY, Please the following:

Name: _____________________________________________ Relationship: ____________________

Address: ____________________________________________________________________________

Contact Number: Home: ____________________________ Work: __________________________

Accomplished by: ___________________________________________ ___________________


Signature over printed name of parent/guardian Date
Reviewed by: ___________________________________________ ___________________
Signature over printed name of CDC Date

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