Laguna Northwestern College Guidance Office
A.Y.
INDIVIDUAL INVENTORY RECORD
We appreciate you considering our school as a partner in your child's education. This will serve as
your child's initial inventory record with us. Please complete this form completely and truthfully, as
we ask. We could use the details and feedback you provide to help your child and identify further
elements that might have shaped their unique identity.
You can be sure that all information obtained from this form will be treated with the utmost
confidentiality.
I appreciate you very much.
Date:
Grade Level:
Name :
Family
Age:
First
Date of Birth:
Child’s Birth Order:
Middle
Nickname
Place of Birth:
eldest
middle child
youngest
only child
Address:
Contact number:
Check which of the following are applicable:
Parents living together
Parents separated
Parent Working Abroad
Father re-married
Mother re-married
Single Parent
Child is living with whom now?
grandparents
Who else lives in the house?
grandparents
uncle
parents
father only
others (specify)
auntie
Widow
mother only
others:
CHILDREN IN THE FAMILY STARTING WITH THE ELDEST (include the applying child)
PARENTS’ RECORD
Information on FATHER
Information on MOTHER
NAME
AGE
DATE OF BIRTH
PLACE OF BIRTH
CITIZENSHIP
RELIGION
EDUCATIONAL
ATTAINMENT
PRESENT OCCUPATION
NAME OF FIRM
ADDRESS OF FIRM
OTHER CONTACT NOS.
(CELL PHONE, EMAIL
ADDRESS ETC.)
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STUDENT’S HEALTH INFORMATION
Height:
Weight:
Have any of the following ailments ever affected your child? Pls. Examine the following to see
whether any of these have harmed your child in the last five years or more:
asthma
convulsion or fits
diabetes
epilepsy
eye defects (pls. specify)
malaria
fainting spells
frequent headaches
hearing defects
heart diseases
hernia
influenza
mumps
tuberculosis
measles
nervousness
pneumonia
smallpox
stammering
typhoid fever
Do you know whether your child has any other special needs or problems, such as ADD, ADHD, LD,
etc.? Provide further details.
Has your child ever had a food, drug, or other allergy? Just be specific.
Has your youngster been in any significant accidents? If so, be specific.
Name of Family Doctor:
Telephone Numbers.:
Office Address:
Preferred Hospital:
EDUCATIONAL INFORMATION
Grade Range/General Average on Report Card:
Awards Received:
School Activities/Club:
Activities Outside the school:
PERSONALITY INFORMATION
Check those which you feel best describe your child’s general personality make-up:
aggressive
anxious
calm
cheerful
confident
conscientious
courteous
neat
shy
honest
independent
irritable
jealous
lacks motivation
lazy
appreciative
kind
sensitive
nervous
optimistic
patient
persevering
feels inferior
friendly
pessimistic
stubborn
smart
Others, please specify:
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SOCIAL RELATIONSHIPS
Please check any of the items that apply to your child.
At home:
discusses problems with father
discusses problems with mother
enjoys the company of siblings
enjoys family outings/affairs
friendly with household help
generous with his/her things
Others, please specify:
asserts himself/herself
demanding
goes only with familiar people
prefers to be left alone
often fights with people in the house
difficult to deal with
In school:
would rather be a follower
friendly with the people in school
enjoys the company of classmates
interested in class activities
asserts himself / herself
Others, please specify:
is looked as a leader
afraid of teachers/other students
would rather be alone
goes only with familiar people
always in trouble with classmates
CAPACITY AND INTEREST
Please check any of the items that best describes your child:
impatient
poor in comprehension
slow learner
has short memory
has academic difficulties
creative
eager to do activities
finishes tasks easily
learns quickly
orderly
inquisitive
imaginative
Others, please specify:
Please fill out the following information about your child's hobbies and favorites:
1. games
2. kinds of food
3. place he/she usually enjoys
OTHER PERTINENT INFORMATION
Describe momentous occasions or noteworthy incidents that occurred in your child's life.
Write down any issues, disputes, challenges, or concerns that you believe disturb your child.
What assistance would the guidance counselor be able to provide at this time? Please include
any additional information you feel is important for the development of your child.
On what day would you find it most convenient to attend the parenting seminars? _
Father’s Signature __________________
Mother’s Signature ____________________
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