Republic of the Philippines

Region VIII (Eastern Visayas)

ROMUALDEZ ELEMENTARY SCHOOL

Division: Leyte
School: Romualdez Elementary School
Address: Brgy. Romualdez, Dulag, Leyte
Pupil’s Name: ________________________________________ Grade: 4
Pupils Address: Brgy. Romualdez, Dulag, Leyte
Name of Parent/Guardian: ______________________________

Dear Parents/Guardian:
Good Day!

Romualdez Elementary School will conduct a National Deworming to Grade four female pupils in coordination with the
Department of Health (DOH) through the District Nurse of Dulag North District or any medical personnel of Dulag Municipal office,
Dulag, Leyte.
This notification is being issued to you as an information of the activity that will be conducted on the month of February 18,
2019. Should you have further questions /clarifications on this matter, please get in touch with Mrs. Editah A. Ala School Head or
Mrs.Lyn-Lyn M. Yu a Grade 4 Adviser
Thank You for your cooperation.
Very Truly Yours,

LYN-LYN M. YU
Teacher Adviser

ACKNOWLEDGEMENT AND CONSENT

This is to acknowledge receipt of the Notification Letter regarding the conduct of National School Deworming
I have read and understood the information regarding the intended health services to be given to my child.

Please check in the box provided

Yes, I will allow my child to be provided the health services as per DOH recommendation.

No, I will not allow my child to receive the health services benefits.
Reason:_________________________________________________

______________________________
Signature over Printed Name

Republic of the Philippines

Region VIII (Eastern Visayas)
ROMUALDEZ ELEMENTARY SCHOOL

Division: Leyte
School: Romualdez Elementary School
Address: Brgy. Romualdez, Dulag, Leyte
Pupil’s Name: ________________________________________ Grade: 4
Pupils Address: Brgy. Romualdez, Dulag, Leyte
Name of Parent/Guardian: ______________________________

Dear Parents/Guardian:
Good Day!

Romualdez Elementary School will conduct a National Deworming to Grade four female pupils in coordination with the
Department of Health (DOH) through the District Nurse of Dulag North District or any medical personnel of Dulag Municipal office,
Dulag, Leyte.
This notification is being issued to you as an information of the activity that will be conducted on the month of February 18,
2019. Should you have further questions /clarifications on this matter, please get in touch with Editha A. Ala School Head or
Mrs.Lyn-Lyn M. Yu a Grade 4 Adviser
Thank You for your cooperation.
Very Truly Yours,

LYN-LYN M. YU
Teacher Adviser

ACKNOWLEDGEMENT AND CONSENT

This is to acknowledge receipt of the Notification Letter regarding the conduct of the National School Deworming.
I have read and understood the information regarding the intended health services to be given to my child.

Please check in the box provided

Yes, I will allow my child to be provided the health services as per DOH recommendation.

No, I will not allow my child to receive the health services benefits.
Reason:_________________________________________________

______________________________
Signature over Printed Name