Annex B.

1 Form 1- Classroom Level

Region: X-Northern Mindanao Division: Iligan City

Name of School: Dalipuga Central School School ID: 128113 District: North 1
Grade & Section: ACHIEVER Adviser: PAMELA G. PALANGAN
Enrolment: Male :14 Female: 17 Total : 31 Dewormed: Male: 10 Female: 8 Total: 18

Dewormed If no, indicate Reason

No. Name of Child
Yes No
1 ALMEROL, VENCI, F. √
2 BERLAN, VAN ARON, J. √
3 CAUSIN, ELIJAH JOSH, D. √ Already done by parents
4 GAID, KLENT DAVE, B. √
5 IBAY, JARED VINCE, A. √
6 LAGUIDAO, MARK JHON, G. √
7 LAGUROS, KRISTOFF, A. √
8 MALLARI, REYMARK, L. √
9 MANALO, FRANZ JAYDEN, B. √
10 MIGRINIO, RINIEL, G. √
11 NAYGA, JOHN REX, S. √ Already done by parents
12 NOVICIO, JAN DASHIEL, B. √ Already done by parents
13 REOBILO, RAMON, G. √ Already done by parents
14 SARINO, JEBRIAN DAVE, G. √
15 ANTIOLA, XYZA ROBHELIA, E. √ Already done by parents
16 BASALLO, PRECIOUS CHLOE, A. √
17 DITUCALAN, RAYHANISA, T. √ Already done by parents
18 EMANO, CHANCES MIANNE, B. √
19 LACANG, MAJA ALEXANDRA, A. √ Already done by parents
20 LIGAD, CLOE, P. √ Already done by parents
21 MALANOG, LYKA FAITH, P. √
22 MANOS, JEZANIAH GRACE, A. √ Already done by parents
23 MENDEZ, KISHIA MAE √
24 MUANA, MA THERESA, C. √ Already done by parents
25 OMANDAC, JENEFFER, F. √
26 PAGHASIAN, CATHERINE, T. √ Already done by parents
27 PURAY, AIZEL DANE, B. √
28 QUIOBE, MICAH CYRIEL, M. √ Already done by parents
29 SHIEK, DIQSY, P. √ Already done by parents
30 TECSON, RHIZEL MAE, A. √
31 TRAYA, CHRYSM HEWHAY, R. √
TOTAL 18 13

Prepared by:

PAMELA G. PALANGAN
Teacher In-charge