Republic of the Philippines

Department of Education
Schools Division of Bulacan
District of Pandi North
CACARONG ELEMENTARY SCHOOL

PARENTS’ CONSENT ON LIMITED FACE TO FACE CLASSES CHECKLIST

Grade 2 – Santan
SY 2021 – 2022

Vaccination Status
No. Name of Learner Agree Disagree Not Willing to be
Vaccinated Vaccinated Vaccinated
Male
1 AGUIRRE,JOHN CARLO, MATEO
2 ALHASSAN,BERUEL YUNUSA, OPALLA

3 BALITON,RAINNER, BALOLOY

4 CANONCE,JOHN, MANAOG

5 CAPALAD,FRANK JHAYVIER, ANTONIO

6 CRUZ,JHON RENZO, ESTEBAN

7 DE LEON,VINCENT, LAPUZ

8 DELA MERCED,MARK ANTHONY, JR ALTICHE

9 ESTACO,PATRICK, CORPIN

10 FORNAL,JAIRUS, LACANARIA
11 GARCIA,MATT AARON, BOBIS
12 LAGASCA,JOSHUA, ASNE
13 LASPONIA,CHRISTIAN, CASPE
14 MANDIN,JUSTIN, TABARA
15 MATEO,GERALD, SANCHEZ
16 MORALES,JOHN DAVE, DELA CRUZ
17 NOTARIO,EMMANUEL, BARCIAL
18 OBAS,ROGIE, EMIT
19 POQUIZ,VERGEL, BALLADARES
20 RIVERA,RAIN VINCENT, RAMOS

Address: Cacarong Matanda, Pandi, Bulacan

Email Address: 104973@deped.gov.ph
Contact Number: 044-816-7580
 Republic of the Philippines
Department of Education
Schools Division of Bulacan
District of Pandi North
CACARONG ELEMENTARY SCHOOL

21 TAGAILO,MATT KENNETH, ABO

22 VECIDA,KEN CHARLES, SELORIO
23 YACO,MICHAEL RHAY, SILVERIO
Female
1 ARCHES,CYRAH, PONO
2 CEJAS,MITCHIE, PEREZ

3 ESPINA,JOCEL, DUMAPIAS

4 ESPINOSA,JASMINE, DE LUNA

5 ESTEBAN,PAULINE, LAGUNSAD

6 FRANCISCO,RHINA, GREJALVO

7 GEVE,TRIXIE MHAY, MADLANGSAKAY

8 HERMAN,JUNNICA ANNE, GOZO

9 JACINTO,LILY ROSE, SALVADOR

10 LACABA,BEA MAE, CACATIAN

11 MACAPOBRE,CHERRIE ANNE, GUARIN

12 MANALASTAS,LHIANE WYNNE, DELA CRUZ

13 MARINDUQUE,RYZA MAE, TEMPORADA

14 MONTILLA,ANALYN, CONCHAS

15 PORMALEJO,RAMELA THIRDY MARU, PADIS

16 REYES,SAMANTHA, COMENDADOR

17 REYES,TRISXHA MHAE, MALIG-ON

18 TORRES,JAZZCYL RAIN, GOTINGGA

Vaccination Status
No. Name of Learner Agree Disagree Not Willing to be
Vaccinated Vaccinated Vaccinated
16
17

Address: Cacarong Matanda, Pandi, Bulacan

Email Address: 104973@deped.gov.ph
Contact Number: 044-816-7580
 Republic of the Philippines
Department of Education
Schools Division of Bulacan
District of Pandi North
CACARONG ELEMENTARY SCHOOL

18
19
20

SUMMARY:

● On Limited Face to Face Classes

Agree Disagree
Male
Female

Total

● Vaccination Status
Not Willing to be
Vaccinated
Vaccinated vaccinated
Male
Female

Total

Address: Cacarong Matanda, Pandi, Bulacan

Email Address: 104973@deped.gov.ph
Contact Number: 044-816-7580
 Republic of the Philippines
Department of Education
Schools Division of Bulacan
District of Pandi North
CACARONG ELEMENTARY SCHOOL

Prepared by: Noted:

MARIANNE ROSE A. BILAOS CLARISSA D. SERPA JUAN

Teacher I School Principal II

Address: Cacarong Matanda, Pandi, Bulacan

Email Address: 104973@deped.gov.ph
Contact Number: 044-816-7580