Enrollment Form – Liceo de Luisiana

San Pablo Diocesan Catholic Schools System

Liceo de Luisiana

Plaza Rizal St., Brgy. Sta Catalina, Majayjay, Laguna 4005
School ID: 402556 • Contact No: 049-563-2206

Enrollment Form / Registration Form

Enrollment Type

* required

Enrollment Date * Must be today's date

School Year *

Remarks (optional)

Enrollment Type *

Old New Transferee

Student Details

Full Name *

Learner Reference Number (LRN) * Numbers only, exactly 12 digits

Grade Level / Strand *

Birthday * Minimum age is 3 years old Must not be a future date

Birthplace *

Address *

Cellphone No. * Numbers only, must start with 09

Sex *

Email Address * Use any valid email; no spaces or special symbols like # % &

Parent / Guardian Information

Father's Name *

Father's Contact *

Father's Occupation *

Mother's Name (Maiden Name) *

Mother's Contact *

Mother's Occupation *

Guardian Name *

Guardian Contact *

Guardian Email *

Previous School

Last School Attended *

Requirement/s Submitted

PDF, JPG, JPEG, PNG accepted (Max 10MB per file)

PSA Birth Certificate * Photocopy / Original

Baptismal Certificate * Photocopy / Original

Card / Form 138 * Latest report card

Good Moral Certificate * Certificate from previous school

Form 137 * Permanent record / cumulative form

Data Privacy Consent and Certification

🔒 Data Privacy Act of 2012 – RA 10173

I hereby certify that the information provided in this form is true and correct.

I give consent to the processing of my personal and sensitive personal data for legitimate school purposes in accordance with the Data Privacy Act of 2012 and its Implementing Rules and Regulations. The school shall ensure that all collected data will be kept confidential and secured, and will not be shared with third parties without my written consent, except as required by law or authorized by the National Privacy Commission.

I have read and understood the above Data Privacy statement, and I freely give my consent to the collection and processing of my personal data. *

Student's Signature (type full name) *

Parent / Guardian's Signature (type full name) *