Registration Form

Lord of Zion Divine School, Inc.

Poblacion, Bacnotan La Union
09771053809 / 072-610-1969
lordofziondivineschool@gmail.com | lordofziondivineschool@yahoo.com

STUDENT REGISTRATION FORM

I. PERSONAL DATA
Note: If not applicable, please write N/A. For the Suffix Name, leave it blank.
Lastname: *	Suffix:
Firstname: *
Middlename: *	Gender: *	Male Female
Birthdate: M/D/Y *	Age: *
Nationality: *
Religion: *	Email:
Date & Place of Baptism: *
Date & Place Of Confirmation: *
Mobile No: *	Telephone No:
Province: *
Municipality: *
Barangay: *
Street Address: *

II. FAMILY RECORD
Note: If not applicable, please write N/A.
Current SMS Recepient: *
Mother's Name: *	Occupation: *
Email:*	Work Addres:
Contact No: *	Annual Income:*	Below Minimum (14,000.00)
		Above (15,000.00)
		Mid Class (20,000.00)
		Mid Class (20,000.00)
Father's Name: *	Occupation:*
Email: *	Work Addres: *
Contact No: *	Annual Income:*	Below Minimum (14,000.00)
		Above (15,000.00)
		Mid Class (20,000.00)
		Mid Class (20,000.00)
Guardian's Name: *	Relation: *
Email: *	Work Address: *
Contact No: *
Note: Please Tick for Receiver
Mother Side Father Side Guardian
Fetcher's Name:
Fetcher's Contact No:

Name of Brothers / Sisters of Student	Age	School/Occupation

III. EDUCATIONAL BACKGROUND
Note: If not applicable, please write N/A.
School Last Attended:	Academic Year:	Address:

IV. REASONS FOR APPLYING (optional)

V. STUDENT DOCUMENT
Student Requirement Documents
	PSA Birth Certificate
	SF 9 (Report Card)
	SF10 (Permanent Record)
	2 Long White Folder
	2pcs (2x2) picture with white background
	ESC Grantee Certificate (JHS & SHS)
	Birth Certificate
Special Arrangements and Conditions
	I commit to being an active and responsible student at Lord of Zion Divine School. I will prioritize my education, attend classes regularly, and uphold academic integrity. I will treat others with respect, follow the school's code of conduct, and maintain a positive learning environment. I will respect privacy, prioritize health and safety, fulfill financial obligations, and use school property responsibly. By signing this commitment, I pledge to embrace these principles and contribute positively to the school community.