2021-01-19 06:45:05 St. Dominic
SeniorHigh Application Form

PERSONAL INFORMATION
ADDRESS
City
Barangay

FAMILY INFORMATION


Sibling 1:



Sibling 2:



Sibling 3:



ACADEMIC BACKGROUND
*ESC ID no. and QVR Code can be found on your ESC certificate or QVA certificate.
Extra-Curricular Activities
OTHER INFORMATION

HEALTH INFORMATION


Allergy / Surgery:
Visual Acuity:
Normal Vision
Wears Eyeglass
Auditory Perception:
Normal Hearing
Wears Hearing Aid
Physical Condition:
Normal Condition
Psychological Condition:
Normal Condition

HEALTH DECLARATION FORM

I certify that the above history is true to the best of my knowledge. I have fully disclosed all medical conditions that may affect my performance as a student of the school. I also understand that the School Health Services and the Guidance Office will not be liable to any untoward incident that may arise due to the deferral of the psychological service recommendation, physical examination and Chest X-ray.


I AGREE AND UNDERSTAND

SOCIAL ENVIRONMENT AND BEHAVIOR
Preferred Course/s in SDCA:

TERMS AND CONDITION

I of legal age, hereby voluntarily and knowingly authorize St. Dominic College of Asia to collect, process or release my personal and sensitive information that may be used for internal and external school official and legal transactions. I agree on the following conditions:

  1. Personal Information will be released unless written notice of revocation is received by the Data Privacy Office of St. Dominic College of Asia.
  2. Personal information may be released for school official and legal purposes only.
  3. Sensitive information will be kept confidential unless the school deemed it necessary to release on valid and legal purposes only.
  4. Updating and modifying of incorrect, inaccurate or incomplete personal information will be done upon submission of letter of request to St. Dominic College of Asia.
  5. St. Dominic College of Asia and its officials and employees are not held liable for the collection and release of any information that I voluntarily provided.

I have read this form, understood its contents and consent to the collecting, processing and releasing of my personal data. I understand that my consent does not preclude the existence of other criteria for lawful processing of personal data, and does not waive any of my rights under the Data Privacy Act of 2012 and other applicable laws.

Fill out completely and Legibly all the information needed. Any false statement, misterpretation or material omission made herein shall be considered as gross dishonest/fraud and will be ground for your disqualification, suspension, dismissal, expulsion or dropping of your name from the rolls of the school.

CORE VALUES
St. Dominic College of Asia performs its various roles toward the achievement of its Vision-Mission-Goals as it anchors itself on a four-point set of core values:
S – service , D – dynamism , C – competence , A – accountability ,