Southbrook Academy Enrollment Form

3334 Sitio Pungsod
Lawaan III, Talisay City, Cebu

Phone 09272332137/09397581595/5134106

As a good and cooperative member of Southbrook Academy, Inc. Educating Community, I promise to abide by the rules and regulations of Southbrook Academy, Inc. I also understand that my failure to cooperate with the school towards the integral formation of my child would lead to the forfeiture of his/her slot in th school for the following school year.

    [md-form] [md-text label="Learner Reference Number (LRN)"] [/md-text] [md-text label="Full Name"] [/md-text] [md-text label="Email"] [/md-text] [md-text label="Phone Number"] [/md-text] [md-select label="Select Gender"] [/md-select] [md-text label="Date of Birth"] [/md-text] [md-text label="Place of Birth"] [/md-text] [md-text label="Age"] [/md-text] [md-text label="Nationality"] [/md-text] [md-text label="Religion"] [/md-text] [md-text label="Birth Rank (Min Value of 1)"] [/md-text] [md-text label="Student Home Address"] [/md-text] [md-text label="Street Address"] [/md-text] [md-text label="Address Line 2"] [/md-text] [md-text label="City"] [/md-text] [md-text label="State/Province"] [/md-text] [md-text label="Postal/Zipcode"] [/md-text] [md-text label="Country"] [/md-text] [md-select label="Educational Alternative" help= "Please review the Agreement accessible from the Download button above"] [/md-select] [md-text label="Mother's Maiden Name"] [/md-text] [md-text label="Mother's First Name"] [/md-text] [md-text label="Mobile Number"] [/md-text] [md-text label="Mother's Occupation"] [/md-text] [md-text label="Mother's Position"] [/md-text] [md-text label="Street Address"] [/md-text] [md-text label="Address Line 2"] [/md-text] [md-text label="City"] [/md-text] [md-text label="State/Province"] [/md-text] [md-text label="Postal/ Zipcode"] [/md-text] [md-text label="Country"] [/md-text] [md-text label="Mother's Email Address"] [/md-text] [md-text label="Work Number"] [/md-text] [md-text label="Father's Maiden name"] [/md-text] [md-text label="Father's First Name"] [/md-text] [md-text label="Mobile Number"] [/md-text] [md-text label="Father's Occupation"] [/md-text] [md-text label="Father's Position"] [/md-text] [md-text label="Street Address"] [/md-text] [md-text label="Address Line 2"] [/md-text] [md-text label="City"] [/md-text] [md-text label="State/Province"] [/md-text] [md-text label="Postal/ Zipcode"] [/md-text] [md-text label="Country"] [/md-text] [md-text label="Father's Email Address"] [/md-text] [md-text label="Work Number"] [/md-text] [md-select label="Outlined select"] [/md-select] [md-text label="Full Name"] [/md-text] [md-text label="Primary Contact Name"] [/md-text] [md-text label="Primary Contact Phone Number"] [/md-text] [md-text label="Secondary Contact Name"] [/md-text] [md-text label="Secondary Contact Phone Number"] [/md-text] [md-checkbox label="Allergic Reaction to"] Cat HairDustPollenFoodMoldOtherNo Allergies [/md-checkbox] [md-textarea label=" If Food or Other Please Specify"] [/md-textarea] [md-textarea label="Please Specify Current Medication"] [/md-textarea] [md-checkbox label="If the child gets sick what medicine(s) should the nurse or teacher administer?"] BiogesticParacetomolTempraOther [/md-checkbox] [md-textarea label=" If Other Please Specify"] [/md-textarea] [md-text label="Name of Guardian"] [/md-text] [md-text label="Relationship to the Student"] [/md-text] [md-text label="Pesos"] [/md-text] [md-text label="Cents"] [/md-text] [md-file label="Please attach a copy of the receipt" help="png,jpg,pdf"] [/md-file] [md-text label="Accomplished By"] [/md-text] [md-text label="Date"] [/md-text] [md-accept label="PROCESS COMPLETION: By checking the box below you will agree to the terms and you will initiate the 2500php payment process on PayPal. If you are paying by a different method, you can just ignore the PayPal redirect." terms="I have read and agree to the Terms & Conditions between Parents and School"] [/md-accept] [md-submit] [/md-submit] [/md-form]