Brain Train Is 2015

BRAIN TRAIN STUDENT INFORMATION SHEET
IMPORTANT: MUST BE FILLED OUT COMPLETELY! THIS WILL BE USED IN SECTIONING AND SEATING
ARRANGEMENT AND IN ISSUING ANNOUNCEMENTS AND STUDENT ASSESSMENTS. NO BLANKS PLEASE!
Name _________________________________________________________ Nickname___________ Height _____

Last Name First Name Middle Name
Home Address ____________________________________________________________________________________
Tel. No. Landline _____________ Mobile _______________________ Email __________________________________
Fathers Name _________________________________ Business or Office Address ____________________________

Mothers Name ________________________________ Business or Office Address _____________________________

School (pls. do not abbreviate) ENROLLMENT DETAILS
__________________________________________________________ Date: _______________________________
Recent school grades (pls. estimate and do not leave blank) Enrolling for:
Math _____ Science _____ English _____ Average Grade _____ High School Entrance Review
Class/Batch Rank _____ out of _____ Pilot Section? yes no n/a UPCAT/College Entrance Review
Academic Awards Received ____________________________________ Summer Enrichment
Venue and Schedule: ___________________
Does the student have special needs or a handicap? (poor eyesight, ADHD, Initial payment: _______________________
autism, attitude problems, etc.) yes no Signed RCA? yes no
If yes, what: ________________________________________________ I have received and understood the contents
of the Review Guide and the PLS READ Flier.
How did you know about BRAIN TRAIN? ___________________________
____________________ _______________
---DO NOT FOLD OR SOIL--- Printed Name Signature
BRAIN TRAIN STUDENT INFORMATION SHEET

IMPORTANT: MUST BE FILLED OUT COMPLETELY! THIS WILL BE USED IN SECTIONING AND SEATING
ARRANGEMENT AND IN ISSUING ANNOUNCEMENTS AND STUDENT ASSESSMENTS. NO BLANKS PLEASE!
Name _________________________________________________________ Nickname___________ Height _____

Last Name First Name Middle Name
Home Address ____________________________________________________________________________________
Fathers Name _________________________________ Business or Office Address ____________________________

Mothers Name ________________________________ Business or Office Address _____________________________

School (pls. do not abbreviate) ENROLLMENT DETAILS
__________________________________________________________ Date: _______________________________
Recent school grades (pls. estimate and do not leave blank) Enrolling for:
Math _____ Science _____ English _____ Average Grade _____ High School Entrance Review
Class/Batch Rank _____ out of _____ Pilot Section? yes no n/a UPCAT/College Entrance Review
Academic Awards Received ____________________________________ Summer Enrichment
Venue and Schedule: ___________________
Does the student have special needs or a handicap? (poor eyesight, ADHD, Initial payment: _______________________
autism, attitude problems, etc.) yes no Signed RCA? yes no
If yes, what: ________________________________________________ I have received and understood the contents
of the Review Guide and the PLS READ Flier.
How did you know about BRAIN TRAIN? ___________________________
____________________ _______________
---DO NOT FOLD OR SOIL--- Printed Name Signature

UPCAT Refresher & Intensive ACET/DLSUCET Registration Form UPCAT Refresher & Intensive ACET/DLSUCET Registration Form
Date: ______________________ Date: ______________________

Name: ________________________________________________________ Name: ________________________________________________________
School: ________________________________________________________ School: ________________________________________________________
BT Review Venue: ____________ Section:_____ Reviewee No.___________ BT Review Venue: ____________ Section:_____ Reviewee No.___________
Contact Nos. Contact Nos.
Student: ____________________ Student: ____________________
Father: _____________________ Father: _____________________
Mother: _____________________ Mother: _____________________
Email Address Email Address
Father:________________________________________ Father:________________________________________
Mother:________________________________________ Mother:________________________________________
Enrolling for: Enrolling for:
UPCAT Refresher Venue: _________________ Date: ____________ UPCAT Refresher Venue: _________________ Date: ____________
Intensive ACET/DLSUCET Venue: _________________ Date: ____________ Intensive ACET/DLSUCET Venue: _________________ Date: ____________

STAPLE THIS TO YOUR REVIEW MANUAL. THIS MUST BE PRESENTED STAPLE THIS TO YOUR REVIEW MANUAL. THIS MUST BE PRESENTED
DURING THE REVIEW. DO NOT LOSE THIS! DURING THE REVIEW. DO NOT LOSE THIS!
Date: ______________________ Date: ______________________
This is to certify that ______________________________________________ This is to certify that ______________________________________________

has paid the amount of P___________________ as full payment for _______ has paid the amount of P___________________ as full payment for _______
_____________________________________________________to be held at _____________________________________________________to be held at
_________________________________ on ___________________________. _________________________________ on ___________________________.
Payment & Student Reg. Form received Payment & Student Reg. Form received
by: by:
_______________________________ _______________________________
Authorized BT Representative Authorized BT Representative

Brain Train Is 2015

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BRAIN TRAIN STUDENT INFORMATION SHEET

Name ___________________________________________________ Nickname_ Height _

Fathers Name _____ Business or Office Address

Mothers Name ____ Business or Office Address _

BRAIN TRAIN STUDENT INFORMATION SHEET

Name ___________________________________________________ Nickname_ Height _

Fathers Name _____ Business or Office Address

Mothers Name ____ Business or Office Address _

Date: Date:

Date: Date:

This is to certify that This is to certify that

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