________________ CLUB APPLICATION FORM
This _________________ Club Application Form is a statement of your
best knowledge and understanding of the club you are applying for.
Instruction: Please supply the information requested in the space
provided.
Place your
2X2 Picture Here
I. PROFILE
Learner’s Name: ______________________________________________
(Surname, Given Name, Middle Name, & Extension Name e.g., Jr., I..)
Grade Level: __________________________________________________
Club/Organization Applied for: ________________________________
Gender:
Age:
Email Address:
Date of Birth:
Mobile No.:
Landline:
Home Address:
II. LEARNER’S ACADEMIC AND BEHAVIORAL STATUS
1. Has no failing grades in all subject areas
Attested by:
Class Adviser Name & Signature
EsP/Guidance Coordinator Name
& Signature
No
Yes
No
Date:
2. Is of good moral character
Attested by:
Yes
Date:
Kindly attach a photocopy of your School Form 9 [Learner’s Progress Report Card and Certificate of Good Moral.
III. PARENTAL CONSENT
I,
_______________________________________________
__________________________________________________, will
___________________ club with the best of my ability.
as
a
support
parent/
guardian
his/her commitment
of
to
I am allowing him/her to participate in the programs, projects, and activities as a member
of ___________________ club.
I agree and understand the commitment of my son/daughter and will support his/her
endeavor to the club they have chosen to apply for.
_____________________________________________
Name and Signature of the Parent/Guardian
______________________________
Contact Number
IV. CERTIFICATION
I am filing this ___________________________ Club Application Form for the school year
________________.
I hereby certify that the facts stated herein are true and correct to the best of my
knowledge.
_______________________________________________________
Signature of Student over Printed Name
Verified by:
_________________________________________
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______________________________________
Club Adviser ︎ ︎ ︎ ︎ ︎ ︎ ︎ ︎ ︎ ︎ ︎ ︎ ︎ ︎ ︎