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SCHEDULE: _____________________________
Total Number of Participants: 25 participants VACCINATED Resource Person: __________________________
For the month/s of: OCTOBER 2022 Contact Number: 02-8-651 3556
Location/Area: Barangay 163 Zone 14 District 2 Sponsor: BLACKTOWN PONDS LIONS CLUB INC.
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AGE
Name of Participants Parent / Guardian Date of Birth BRAND
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