Republic of the Philippines

Department of Education
Region VIII-Eastern Visayas
Schools Division of Calbayog City
Calbayog I District
BAGACAY ELEMENTARY SCHOOL
Calbayog City

DEWORMING FORM
GRADE 3-1
SY: 2016-2017

PARENTS PERMIT
Ako si (magulang), (relasyon) nagbibigay ng pahintulot na si (pangalan ng anak) ay pwede
painumin ng gamut para sa pagpatay ng bulate sa paaralan ng Bagacay Elementary School ni
_________________________ ng pansangay, sa Lungsod ng Calbayog.
(Tagapangasiwa ng Kalusugan)
Name of Student Age/Edad Name/Signature of 1st Dose 2nd Dose
No. Remarks
(Pangalan ng Anak) Yr.:Mos. Parent/Guardian June-Dec. Jan.-March
Male
1 Afan, Andreen
8:06
Florence Y.
2 Aresgado, Mark
8:07
Xander O.
3 Bernadit, Jared R. 8:08
4 Bernadit, Warren L. 13:09
5 Calda, Denver S. 11:01
6 Calicdan, Jeremy F. 8:06
7 Capongcol, Mark Wyne
8:09
D.
8 Egonio, Christian Vic
9:08
D.
9 Estrelles, Keven P. 10:01
10 Mateo, Pepito C. Jr. 13
11 Navarro, Jholo D. 13
12 Orquilla, Kian Jay R. 10:01
13 Saludar, Jasper R. 10:03
14 Saludar, Joncel R. 8:06
15 Tamaki, Raymay C. 9:05
16 Tambis, Rico D. 10:08
17 Tarrayo, Nathaniel T. 8:06
18 Tionelo, Vernard C. 10:05
19 Torrijas, Jhonrell T. 10:11
Female
1 Abinguar, Rona D. 9
2 Cadano, Angelie C. 9:07
3 Caiyoy, Angelyn T. 8:03
4 Grego, Annabel S. 13:10
5 Lumuntod, Jasmine O. 13:06
6 Mendebel, Hanna 9:04
7 Mendez, Anixsandra C. 8:09
8 Pacampara, Princess
8:05
Kylle T.
9 Prestoza, Romela Mae
9:06
S.
10 Rosero, Shainelyn J. 8:04
11 Rueda, Joannlynne D. 9:07
12 Salunoy, Christaline M. 9:08
13 Sayao, Angela D. 10:01
14 Villanueva, Mary Grace
8:05
S.
Prepared by:
ERLINDA P. BAYANI
Adviser