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  • Survey Form For Limited F2F G10

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    Frank Taquio
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    Survey-Form-for-Limited-F2F-G10

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    12 views1 page

    Survey Form For Limited F2F G10

    Uploaded by

    Frank Taquio

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    IRISAN NATIONAL HIGH SCHOOL IRISAN NATIONAL HIGH SCHOOL

    Purok 3, Irisan, Baguio City Purok 3, Irisan, Baguio City

    Dear Parents/Guardians, Dear Parents/Guardians,


    The school is conducting a survey with regard to the possible The school is conducting a survey with regard to the possible
    limited face-to-face classes this school year. We would like to get your limited face-to-face classes this school year. We would like to get your
    response regarding this as we prepare for a location risk assessment response regarding this as we prepare for a location risk assessment
    and school safety assessment which will affirm that our school is and school safety assessment which will affirm that our school is
    compliant with minimum public health standards set by the government. compliant with minimum public health standards set by the government.
    Relevant to this, may we ask you to honestly accomplish the Relevant to this, may we ask you to honestly accomplish the
    survey form below. Thank you very much! survey form below. Thank you very much!
    The Grade 10 Teachers The Grade 10 Teachers
    Please fill-out and return to the teacher. Please fill-out and return to the teacher.

    Name of Child/Ward: _______________________________________ Name of Child/Ward: _______________________________________

    Grade and Section: ________________________________________ Grade and Section: ________________________________________

    Will you allow your child to participate in limited face-to-face Will you allow your child to participate in limited face-to-face
    classes? classes?
    _____ YES, I will allow my child/ward. _____ YES, I will allow my child/ward.

    _____ NO, I I will not allow my child/ward. _____ NO, I I will not allow my child/ward.
    Reason: Reason:
    _____________________________________________ _____________________________________________

    Does your child have any comorbidity? Does your child have any comorbidity?
    _____ YES _____ NO _____ YES _____ NO

    What is your child’s vaccination status? What is your child’s vaccination status?
    _____ Fully vaccinated _____ Fully vaccinated
    _____ Partially vaccinated (will complete the dose) _____ Partially vaccinated (will complete the dose)
    _____ Partially vaccinated (not willing to complete the dose) _____ Partially vaccinated (not willing to complete the dose)
    _____ Not vaccinated _____ Not vaccinated

    _________________________________________________ _________________________________________________
    Name and Signature of Parent/Guardian Name and Signature of Parent/Guardian

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