Republic of the Philippines

Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF PAMPANGA

CHECKLIST ON LIMITED FACE TO FACE CONSENT

S.Y. 2021-2022

GRADE/SECTION: 5 - BONIFACIO
TEACHER: KIM CARLO M. TRINIDAD

NAME OF PUPILS AGREE NOT AGREE CHOSEN LEARNING MODALITY

FOR THE LIMITED FOR THE LIMITED MODULAR PRINT ON-LINE LEARNING
FACE TO FACE FACE TO FACE
1 ANG,ALJUR, MANANSALA /
CLASSES CLASSES
2 CALIMLIM,JACOB, GAGUI /
3 DANTES,JUSTINE MILES, BAYANI /
4 DAVID,JOHN DERICK, BAUTISTA /
5 DELA CRUZ,JOHN LORENZ, YUMUL /
6 DELA CRUZ,LEE JACOB, - /
7 FLORES,KING JOLAS, CALVO /
8 LACSINA,CHRIS ANGELO, DAVID /
9 OCHOA,RAVEN, ESTRONILO /
10 ONAROSA,JOHN DAVID, NUNAG /
11 SANTOS,JOSE CARLO MIGUEL, - /
12 TIGLAO,KING YURI, CONSTANTINO /
13 VIESCA,JAY GRIDE, OCHOA /
14 BAJASAN,MA ANGEL, OBRA /
15 CERVANTES,ASHLEY NICOLE, BUNGAY /
16 GARCIA,MARILLE, SABRIDO /
17 MANABAT,ANN JELIN, INTAL /
18 MANABAT,KYLA MAE, DELA CRUZ /
19 NABONG,DAISY ROSE, DOMINGUEZ /
20 PARULI,NINA LORAINE, LAXA /
21 SIGUA,MARIA EUNICE, BALINGBING

22 SOTTO,AYESHA JOY, ISIP

23
24
25
26
27
28
29
30
TOTAL 17

Prepared by:
KIM CARLO M. TRINIDAD
Teacher-in-Charge
Noted:

JESUSA L. LOBO
Principal II

Address: Purok Centro,Telacsan Macabebe, Pampanga

Telephone No. 0917-5109-271
Email Address: 106102@deped.gov.ph
 
 
 Address: Purok Centro,Telacsan Macabebe, Pampanga
Telephone No. 0917-5109-271
Email Address: 106102@deped.gov.ph
 
 
ublic of the Philippines
rtment of Education
REGION III
ISION OFFICE OF PAMPANGA

TED FACE TO FACE CONSENT

S.Y. 2021-2022

CHOSEN LEARNING MODALITY

TVBI

JESUSA L. LOBO
Principal II
 Republic of the Philippines
Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF PAMPANGA

CHECKLIST ON COVID 19 VACCINATION

S.Y. 2021-2022

GRADE/SECTION: 6 - ISIDORE
TEACHER: KIM CARLO M. TRINIDAD

NAME OF PUPILS PUPIL PARENT

Last Nam First Name Middle Nam FIRST DOSE SECOND VACCINE BOOSTER FIRST DOSE SECOND VACCINE BOOSTER
Ang Aljur Manansala DATE DOSE DATE TYPE/BRAND DATE DATE DOSE DATE TYPE/BRAND DATE
1 6/14/2022
2 Cagungun Mark Daniel Salonga 11/23/21 12/29/21 ASTRAZENECA
3 FLORES MARK STANLEY OAB
4 GARCIA JAEDEE CANO 3/10/2022 3/31/2022 PFIZER 08/24/21 09/21/21 SINOVAC 2/8/2021
5 GONZAGA JUSTINE MERCADO
6 GONZALO nhijel kenneth tubig
7 Lacsina Chris Angelo David 6/14/2022
8 Lopez Kelvin Que 6/14/2022
9 Sitchon Jonel Cayanan
10 TIGLAO KING YURI CONSTANTINO
11 TORRES NATHAN JUSTINE YAMBAO 3/18/2022 4/15/2022 PFIZER 10/18/21 11/15/21 MODERNA
12 Viesca Jay Gride Ochoa 3/7/2022 4/7/2022 PFIZER
13 Canlas Amiee Tiffany Nabong
14 Cervantes Ashley Nicole Bungay
15 GARCIA MARILLE SABRIDO
16 Lobo Erica Miel Trinidad
17 Lopez April Ann Cervantes 6/14/2022
18 Meneses Zyrhel Ochoa 6/14/2022
19 Quiseo Myca Priya laguitan
20 Sigua Maria Eunice Balingbing
21 Yambao Trisha Mae Caseres
22
TOTAL

Prepared by:
KIM CARLO M. TRINIDAD
Teacher-in-Charge

Noted:

JESUSA L. LOBO
Principal II

Address: Purok Centro Telacsan Macabebe, Pampanga

Telephone No. 0917-5109-271
Email Address: 106102@deped.gov.ph