CKSAI Online Enrolment Form
CKSAI ONLINE REGISTRATION FORM FOR S.Y. 2021-2022
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*
 (Surname, Given Name, Middle Name) *
Address *
Birthdate *
MM
/
DD
/
YYYY
Birthplace *
Region *
Age *
Religion *
Sex *
Father's Name (Surname, Given Name, Middle Name) *
Father's Occupation *
Father's Educational Attainment *
Mother's Maiden Name (Surname, Given Name, Middle Name) *
Mother's Occupation *
Mother's Educational Attainment *
Parents' Home Address *
Parents' Tel./Cel. No. *
E-mail Address of Parent/s/Guardians *
Custodial Parents/Guardians (if applicable)
Relationship with Guardian/s
Guardians' Contact Number
Other Children in the Family: Name (Surname, Given Name, Middle Name)
Other Children in the Family: Name (Surname, Given Name, Middle Name)
Is your child taking medication at this time? *
If yes, please specify:
Is there any other special information that the school should know about this child or other family members that  would be of help in providing services for the child?
Child's Primary Language *
Last School Attended by Pupil (if applicable), and Grade Level
Tel. No. of Last School Attended by Pupil
Referred by:
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