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Republic of the Philippines

Department of Education
Region IV-A (CALABARZON)
Division of San Pablo City
CRECENCIA DRUSILA LOPEZ SENIOR HIGH SCHOOL
(San Pablo City Senior High School Stand Alone)
DLMP Compound, Purok4, Brgy. San Roque, San Pablo City

PARENTS/GUARDIANS COMMUNICATION CARDEX

Name: _______________________________________________ Parent Mother


Father
Address: ______________________________________________ Guardian Relative
Other (specify)
Contact No.: ___________________________________________
Name of Student: _______________________________________ Gender: Male Female
Grade and Section: ______________________________________ Quarter: 1st 2nd 3rd 4th
Name of Adviser: _______________________________________ School Year: _________________

Date Reported Type of Encounter Details of Concern Agreed Resolution Signature


Dialogue Parent/Guardian:
________________
Consultation
Home visitation Teacher:
Assembly/Forum ________________

Dialogue Parent/Guardian:
________________
Consultation
Home visitation Teacher:
Assembly/Forum ________________

Dialogue Parent/Guardian:
________________
Consultation
Home visitation Teacher:
Assembly/Forum ________________

Dialogue Parent/Guardian:
________________
Consultation
Home visitation Teacher:
Assembly/Forum ________________

Remarks:
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