APPLICATION FORM1.pdf - PAREF Southridge School

PAREF – SOUTHRIDGE
Private School for Boys
Hillsborough Subd., West Service Rd., Bo. Cupang
Alabang, Muntinlupa City 1770
Phone: (632)842-0506 to 07 Fax: (632)842-1542
Please attach a
recent 1” X 1”
ID photo
APPLICATION FORM
Date of Application _________________________ School Year 200___ - 200___ For Grade/Year ________
APPLICANT INFORMATION
Name: ________________________________________________________ Nickname:___________________
Last Name First Name Middle Name
Birth Date: ______________________ Current Level: ______________________________________
Age: ______________________ Current School: ______________________________________
Citizenship: ______________________ Country of Birth: _____________________________________
Address:___________________________________________________________________________________
Phone Number: ____________________ Languages Spoken: 1 st _______________2 nd _______________
Educational History: (List all previous schools attended, starting with the current school.)
Name of School From Month/Year To Month/Year Grade/Year Level Reason for leaving
ADDITIONAL INFORMATION ON STUDENT-APPLICANT
Has your son ever repeated or skipped a grade or year level [ ] No [ ] Yes, grade/year _________________
Have you ever requested or completed a learning assessment [ ] No [ ] Yes, please elaborate. ____________
of your son
______________________________
Did your son receive remedial help in his previous school [ ] No [ ] Yes, please elaborate. ____________
or elsewhere (academic tutorials, speech therapy, or
______________________________
occupational therapy, etc.)
Has your son received any citation for academic work or [ ] No [ ] Yes, please specify. ______________
extra-curricular activities
______________________________
Has your son had any behavioral or disciplinary problems at [ ] No [ ] Yes, please elaborate. ____________
his previous school(s) or in the neighborhood
______________________________
Does your son have any special health concerns [ ] No [ ] Yes, please specify. ______________
_______________________________
Does your son require regular medication [ ] No [ ] Yes, please specify. ______________
______________________________
Does your son exhibit any notable or special skill in any area [ ] No [ ] Yes, please specify. ______________
_________________________________

PARENT INFORMATION
FATHER
MOTHER
Full Name _________________________________ ________________________________
Citizenship _________________________________ ________________________________
Birth Date _________________________________ ________________________________
Religion _________________________________ ________________________________
Home Address _________________________________ ________________________________
Home Phone Number _________________________________ ________________________________
Mobile Number _________________________________ ________________________________
Occupation _________________________________ ________________________________
Designation _________________________________ ________________________________
Company _________________________________ ________________________________
Nature of Business _________________________________ ________________________________
Office Address _________________________________ ________________________________
Office Phone/Fax _________________________________ ________________________________
Email _________________________________ ________________________________
Educational Background (Schools & Degree Attained)
High School _________________________________ ________________________________
College _________________________________ ________________________________
Post Graduate _________________________________ ________________________________
Marriage: [ ] Church (Year _______________ )
[ ] Civil (Year _______________ )
[ ] Legally Separated (Year _______________ )
[ ] Remarried (Year _______________ )
[ ] Divorced (Year _______________ )
Name of Children Sex Age Date of Birth Current School Current Level

PERSONAL HISTORY
Do all the members of the family live together __________________________
Have you attended any EduChild Course
__________________________
If yes, kindly state the date and place where you attended. __________________________
Does the work of the father or mother necessitate either parent being away from home for longer than one week per
month, as in the case of job circumstances ___________ If so, please state the details ( why and how) ___________
______________________________________________________________________________________________
How did you first come to know about PAREF ____________________________________________________
What made you apply for your child’s admission in this PAREF school ____________________________________
______________________________________________________________________________________________
Please rank the factors below that greatly influenced your decision to apply in Southridge. (1 being the most important
and 5 the least.)
______ Doctrinal and Character Formation
______Academic Reputation of the School
______Proximity to present residence
______Friendship with other parents
Others, please specify. ____________________
____________________
____________________
REFERRALS SECTION: Three referrals from existing PAREF parents or friends who are familiar with the PAREF
system. Kindly solicit the name and signature of the three people recommending you to Southridge.
Recommended by:
Recommended by:
Recommended by:
_______________________________________
_______________________________________
_______________________________________
Please be advised that your son’s application could be turned down if complete and accurate information is not
provided. The school may permanently drop the student after enrollment should there be any misrepresentations on
this form. Southridge reserves the right to determine the placement of the applicant in the grade or year level deemed
most appropriate for his academic proficiency and background.
To the best of my knowledge, the information submitted on this form is true and correct.
____________________________ ____________________________ ______________________
Signature of Father Signature of Mother Date