Student Registration Form
Due to Enhanced Community Quarantine, having of appointment schedule is required. Please answer correctly and completely all the fields.
Learner's Reference Number(LRN):
Student Name*
First Name Middle Name Last Name Suffix
Grade Level*
Nursery Grade 1 Pre-Kindergarten Grade 2 Kindergarten Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10
School branch you want to be enrolled in:*
Section
Leave this field unanswered
Gender
Age
Leave this field unanswered
Birth Date*
Month Day Year
School Year:*
Mother's Maiden Name:*
First Name Middle Name Last Name
Mother's Occupation:
Father's Name:*
First Name Middle Name Last Name
Father's Occupation:
Address
House No.
Barangay
City State / Province
Postal / Zip Code
Mobile Number*
Student Type:*
Old Student Transferee
Previous School:
Address of Previous School:
Parent/Student E-mail
example@example.com
Brimestone Academy Inc. Main Appointment*
Brimestone Academy Inc. Annex Appointment*
Should be Empty: