ICI Senior High Kapatagan Pre-registration Form SY for 2018-2019
To the student and Parent/Guardian: Please fill in all information required.

* denotes required value

Name of Student
Please fill up the information below
Lastname *
Your answer
Firstname *
Your answer
Middlename *
Your answer
LRN (Learners Reference Number) *
Your answer
Sex *
Date of Birth *
MM/DD/YYYY
MM
/
DD
/
YYYY
Place of Birth *
City/Town or Province
Your answer
Nationality *
Your answer
Contact Number
Your answer
Parents Contact Number
Your answer
Referred by
Your answer
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