REGISTRATION SHEET (2021 Heart to HEART Radio-based Instruction)

Municipality: _______________________
Barangay: _________________________
Log PRIMARY CAREGIVER / GUARDIAN/ VERY YOUNG ADOLESCENT / CHILD Cellphone Number Parent/Guardian’s With Radio? Parent Literacy Level
No. PARENT (for Monitoring and Signature Smart phone? A. Can very well read
Information TV? With B. Can read little
Sharing) Internet C. Cannot read
"None" if no phone connection?
Last Name First Name Age Sex Last Name First Name Age Sex With disability? Yes/No.
(M/F) (M/F) if Yes, mention
disability.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
School: _____________________________
Partner Radio Station: _______________
H2H Teacher-Facilitator: ____________

Note: It is suggested that for each pair of parent and VYA, one H2H teacher-facilitator be assigned. For the initial division-wide implementation, the controlled number of pairs is 20. Each pair shall be the subject of regular monitoring and
“kumustahan” by the assigned H2H teacher-facilitator. The discussion with parents during monitoring must be well-documented. It is also suggested that one of the 20 teachers shall be assigned as over-all H2H Coordinator of the School who
shall consolidate all reports for submission to the school head who will endorsed the same to the district supervisors/secondary schools cluster heads who shall consolidate all school reports, case stories and photo documentation for submission to
Save the Children Philippines and DepEd Cotabato Division. All reports for submission shall be in hard and soft copies.

Prepared and Submitted by:

_________________________
School Head