Enrollment

Is the child a Learner with Disability? Yes No
If Yes, specify the type of disability:
Visual Impairment	Learning Disability
a. blind	Emotional-Behavioral Disorder
b. Low vision	Cerebral Palsy
Multiple Disorder	Intellectual Disability
Hearing Impairement	Orthopedic/Physical Handicap
Autism Spectrum Disorder	Special Health Problem/ Chronic Disease
Speech/Language Disorder	a. cancer

DATA PRIVACY CONSENT FORM

(In compliance to the Data Privacy Act 10173 of 2012)

I, parent/guardian of the student am fully aware that Mary the Queen School of Malolos (MQSM) and its duly designated representative, is bound under the Data Privacy Act of 2012 to protect all the personal information I voluntarily submitted as part of child’s enrollment to the institution. This includes but not limited to his/her name, address, names of parents or guardians, birthdate, grades, attendance, disciplinary records, and other information necessary for basic administration and instruction.

The aforementioned information is strictly confidential and can only be accessed through (1) School Admission processes and (2) through my personal consent. I am fully aware that the information collected and processed is related to his/her personal enrollment to the institution and to be used by MQSM in its legitimate interest as an educational institution.

In the same manner, I am also conscious that MQSM may share such information with government agencies pursuant to law or legal processes.

I certify that I have fully read and understood the agreement stated above and agree to its terms.

Fetcher	Fetcher's Name
Contact Number	Relationship	if others please specify:
Fetcher	Fetcher's Name
Contact Number	Relationship	if others please specify:

Dose No	Vaccination ID	Date Vaccinated
Dose No	Vaccination ID	Date Vaccinated

If school will implement other distance learning modalities aside from face-to-face instruction, what would you prefer for your child?
Choose all that apply:
Modular (Print)	Online
Radio-Based Instruction	Blended
Modular (Digital)	Educational Television
Homeschooling

Find a learner Plese fill out all the required fileds.

Mary the Queen School of Malolos

Enrollment Form

For Learners in Senior High School

DATA PRIVACY CONSENT FORM

NEW STUDENT

OLD STUDENT

Find a learner Plese fill out all the required fileds.

Mary the Queen School of Malolos

Enrollment Form

Learner's Data

Learner's Address

Parent's Guardian's

Learner's Fetcher

Returning Learner (Balik Aral)

Learner's Health

Distance Learning

Payments

For Learners in Senior High School

Enrollment Contract

DATA PRIVACY CONSENT FORM

Returning Learner
(Balik Aral)

Enrollment
Contract