Division of Laguna

District of Santa Cruz

BAGUMBAYAN ELEMENTARY SCHOOL
Santa Cruz

HOME VISIT FORM

Date of Visitation: __________________

(Month/Day/ Year)

Suggested Time: ___________________

Pupil’s Name: _____________________________________________________________

Parents/ Guardian’s Name: ___________________________________________________
Address: __________________________________________________________________
Pupil’s Grade Level (Encircle one): K I II III IV V VI
Duration of Home Visit: 15 minutes 30 minutes 45 minutes over 1 hour

Purposes:
Pupil’s Attendance Help Parents Tutor Son/ Daughter

Pupil’s Health Permission for Pupil Participation

Pupil’s Academic Progress Help Parent Receive Assistance

Pupil’s Behavior Explain Recreation Program

Collect Information for Records Other Reason ______________________________

Explain School Program ______________________________

Purpose for Return Visit:

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COMMENTS:
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Parent’ Signature
Contact #: ______________________

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Teacher’s Signature over printed name

Shared Information with Grade Leader