HV Form

Republic of the Philippines

Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: ________________________
Address: ______________________________________
Contact Number: _______________________________
Name of Student: _______________________________
Section: _______________________________________
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name

Submitted by: Noted by:

HV Form
KEITH ADRIAN C. VILLARAN GRACIELA O. ESTRELLA
Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: Evelyn Escame
Address: Brgy. Iglesia, Cardona, Rizal
Contact Number: 09659033203
Name of Student: Jerome Palo
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form
Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: Evelyn Flores
Address: Brgy. Iglesia, Cardona, Rizal
Contact Number: 09635011704
Name of Student: Mark Santiago
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: Jonalyn Terańa
Address: Brgy. Del Remedio, Cardona, Rizal
Contact Number: 09679213804
Name of Student: John Kurtlyn Terańa
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: Kilet Alejandro
Address: Alejandro St. Brgy. Patunhay, Cardona, Rizal
Contact Number: None
Name of Student: Jackielyn Alejandro
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: Jennifer Arboleda
Address: Alejandro Brgy. San Roque, Cardona, Rizal
Contact Number: 09059085869
Name of Student: Jean Ritch Arboleda
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: Jennifer Arboleda
Address: Alejandro Brgy. San Roque, Cardona, Rizal
Contact Number: 09059085869
Name of Student: Ritch Jean Arboleda
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: Minnielayn Arriola
Address: Brgy. Patunhay, Cardona, Rizal
Contact Number: 09658757541
Name of Student: Anna Dominique Arriola
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: __________________________
Address: Liwanag St. Brgy. Iglesia, Cardona, Rizal
Contact Number: __________________________________
Name of Student: Jan Dianne Cris Martinez
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: ___________________________
Address: Brgy. Calahan, Cardona, Rizal
Contact Number: __________________________________
Name of Student: Stephanie Reyes
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: Reynante Urguelles
Address: Brgy. Iglesia, Cardona, Rizal
Contact Number: 09556915435
Name of Student: Benice Urgelles
Section: 9-Cartesian
Date of Visit: _____________________ Time: ___________

REASONS FOR HOME VISITATION

______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
District of Cardona
BERNARDO F. SAN JUAN NATIONAL HIGH SCHOOL
Rodriguez St. Brgy. San Roque, Cardona, Rizal

REPORT OF HOME VISITATION

HOME VISITATION FORM MINUTES OF THE

MEETING
Name of Parent/Guardian: ____________________ -Failure to submit outputs during assigned
Address: ____________________________ schedule of distribution and submission
Contact Number: _______________ -Not responding to messages
Name of Student: _________________ -Performance during the first and second
Section: 9-Cartesian quarter (report card)
Date of Visit: _____________________ Time: ___________ -Possible consequences of non-compliance
-Possibility of repeating the same grade
REASONS FOR HOME VISITATION level
______ Frequent Tardiness/Absences
______ Failing marks
______ Behavioral problems
______ Non-compliance to school policy/policies
Failure to submit:
______ Outputs/Activity Sheets
______ Projects/Performance Tasks
______ Other Requirements: __________________ Decision of the Parent:
Not responding to: _________________________________
______ Texts messages, phone calls or chats _________________________________
______ Call slips/Invitation to school _________________________________
______ First notice Date: _________________ _________________________________
______ Second notice Date: _________________
______ Third notice Date: _________________
Other reasons for home visitation: ___________________ Parent/Guardian’s Signature Over Printed Name
HV Form

Submitted by: Noted by:

JEDRYLL E. DE LUNA GRACIELA O. ESTRELLA

Teacher Guidance Counselor