Senior High School Enrolment Form Sy. 16-17

HOLY ROSARY ACADEMY OF SIPALAY, INC.
Sipalay City, Negros Occidental 6113

Philippines
ENROLMENT FORM FOR SENIOR HIGH SCHOOL (GRADE 11)
SY. 2016 - 2017
GAS
(Please Print Legibly)
Name:
(Surname) (Given Name) (Middle Name)
Address:
Permanent Address (Street) (City/Municipality) (Province)
Date of Birth:
(Month) (Day) (Year)
Place of Birth:
(Street) (Barangay) (City/Municipality) (Province)
Mother's Name: Age: Occupation:
Father's Name: Age: Occupation:
Guardian's Name: Contact #:
Elem. School Graduated from:
Address of School:
Credentials Submittted: (For Registrar/Enrolling Officer Only)
______ Card _____ Birth Certificate/NSO _______ Good Moral
We, the enrollee and the parents/guardian do hereby agree to abide by all the rules and regulations of
Holy Rosary Academy and the Deparment of Education in matters concerning school discipline and
education while this student is enrolled in this school.
YEAR LEVEL GRADE XI

A. Tuition Fee 14,000.00
B. Standard Fees 1,350.00
C. Other Fees 1,426.00
TOTAL 16,776.00
BREAKDOWN OF FEES
B. Miscellaneous Fees (Standard Fees)
YEAR LEVEL GRADE XI
Registration Fee 200.00
Library 100.00
Athletics 80.00
Medical/Dental 110.00
Guidance Fee 50.00
Laboratory 100.00
PTA Membership 100.00
Student's Handbook 30.00
Development Fee 380.00
Instructional Fee (test papers, etc.) 200.00
Total Standard Fees 1,350.00
C. Other Fees (Non-Standard Fees)

YEAR LEVEL GRADE XI
Computer Fee 800.00
SAO 100.00
Diocesan 300.00
Insurance 26.00
NIDACS 100.00
ID 100.00
Total 1,426.00
Date Enrolled: __________

(Signature or Student/Parent Guardian)
Amount Paid: _________________ OR #: ____________
Cashier' Signature: ___________________

Enrolled as Year Level: ______________________ Approved:
Philippines
SY. 2016 - 2017
TECHVOC
Name:
Address:
Date of Birth:
Place of Birth:
Address of School:
Holy Rosary Academy and the Deparment of Education in matters concerning school discipline and education
while this student is enrolled in this school.
YEAR LEVEL GRADE XI

TOTAL 17,276.00
BREAKDOWN OF FEES
YEAR LEVEL GRADE XI
Library 100.00
Athletics 80.00
Guidance Fee 50.00
Laboratory 100.00

YEAR LEVEL GRADE XI
Computer Fee 1,300.00
SAO 100.00
Diocesan 300.00
Insurance 26.00
NIDACS 100.00
ID 100.00
Total 1,926.00

Amount Paid: _________________ OR #: ____________

Philippines
SY. 2016 - 2017
TECHVOC
Name:
Address:
Date of Birth:
Place of Birth:
Address of School:
Holy Rosary Academy and the Deparment of Education in matters concerning school discipline and
education while this student is enrolled in this school.
YEAR LEVEL GRADE XI

TOTAL 17,500.00
BREAKDOWN OF FEES
YEAR LEVEL GRADE XI
Library 100.00
Athletics 80.00
Guidance Fee 50.00
Laboratory 100.00

YEAR LEVEL GRADE XI
SAO 100.00
Diocesan 300.00
Insurance 26.00
NIDACS 100.00
ID 100.00
Books 224.00
Total 2,150.00

Amount Paid: _________________ OR #: ____________

Philippines
SY. 2016 - 2017
TECHVOC
Name:
Address:
Date of Birth:
Place of Birth:
Address of School:
Holy Rosary Academy and the Deparment of Education in matters concerning school discipline and education
while this student is enrolled in this school.
YEAR LEVEL GRADE XI

TOTAL 17,276.00
BREAKDOWN OF FEES
YEAR LEVEL GRADE XI
Library 100.00
Athletics 80.00
Guidance Fee 50.00
Laboratory 100.00

YEAR LEVEL GRADE XI
SAO 100.00
Diocesan 300.00
Insurance 26.00
NIDACS 100.00
ID 100.00
Books 224.00
Total 2,150.00

Amount Paid: _________________ OR #: ____________

2nd Semester HOLY ROSARY ACADEMY OF SIPALAY, INC. 2nd Semester
Philippines
SY. 2016 - 2017
GAS
Name: Name:
Address: Address:
Date of Birth: Date of Birth:
Place of Birth: Place of Birth:
Mother's Name: Age: Occupation: Mother's Name:
Father's Name: Age: Occupation: Father's Name:
Guardian's Name: Contact #: Guardian's Name:
Elem. School Graduated from: Elem. School Grad
Address of School: Address of School:
Credentials Submittted: (For Registrar/Enrolling Officer Only) Credentials Subm
______ Card _____ Birth Certificate/NSO _______ Good Moral ______ Ca
We, the enrollee and the parents/guardian do hereby agree to abide by all the rules and regulations o We, the e
Holy Rosary Academy and the Deparment of Education in matters concerning school discipline and Holy Rosary Ac
education while this student is enrolled in this school. education while

(Signature or Student/Parent Guardian) Date Enrolled: ___
Amount Paid: _________________ OR #: ____________
Amount Paid: ____
Enrolled as Year Level: ______________________ Approved: Cashier' Signature
Enrolled as Year Le
Semester HOLY ROSARY ACADEMY OF SIPALAY, INC.
Philippines
SY. 2016 - 2017
TECH-VOC
f Birth:
of Birth:
's Name: Age: Occupation:
s Name: Age: Occupation:
an's Name: Contact #:
School Graduated from:
ss of School:
ntials Submittted: (For Registrar/Enrolling Officer Only)
Rosary Academy and the Deparment of Education in matters concerning school discipline and
ation while this student is enrolled in this school.
nrolled: __________
nt Paid: _________________ OR #: ____________
r' Signature: ___________________

d as Year Level: ______________________ Approved:

Senior High School Enrolment Form Sy. 16-17

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HOLY ROSARY ACADEMY OF SIPALAY, INC.

Sipalay City, Negros Occidental 6113

YEAR LEVEL GRADE XI

C. Other Fees (Non-Standard Fees)

Date Enrolled: __________

Cashier' Signature: ___________________

YEAR LEVEL GRADE XI

C. Other Fees (Non-Standard Fees)

Date Enrolled: __________

Cashier' Signature: ___________________

YEAR LEVEL GRADE XI

C. Other Fees (Non-Standard Fees)

Date Enrolled: __________

Cashier' Signature: ___________________

YEAR LEVEL GRADE XI

C. Other Fees (Non-Standard Fees)

Date Enrolled: __________

Cashier' Signature: ___________________

(Surname) (Given Name) (Middle Name)

Permanent Address (Street) (City/Municipality) (Province)

Date of Birth: Date of Birth:

(Month) (Day) (Year)

Place of Birth: Place of Birth:

(Street) (Barangay) (City/Municipality) (Province)

Mother's Name: Age: Occupation: Mother's Name:

Father's Name: Age: Occupation: Father's Name:

Guardian's Name: Contact #: Guardian's Name:

Elem. School Graduated from: Elem. School Grad

Address of School: Address of School:

Credentials Submittted: (For Registrar/Enrolling Officer Only) Credentials Subm

______ Card _____ Birth Certificate/NSO _______ Good Moral ______ Ca

Date Enrolled: __________

(Surname) (Given Name) (Middle Name)

Permanent Address (Street) (City/Municipality) (Province)

(Month) (Day) (Year)

(Street) (Barangay) (City/Municipality) (Province)

's Name: Age: Occupation:

s Name: Age: Occupation:

an's Name: Contact #:

School Graduated from:

ntials Submittted: (For Registrar/Enrolling Officer Only)

______ Card _____ Birth Certificate/NSO _______ Good Moral

r' Signature: ___________________

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