Annex C

Form 1
NATIONAL SCHOOL DEWORMING DAY
Deworming Checklist

Province: Camarines Sur

Division: Camarines Sur
District: Minalabac
Name of School: MATAOROC ELEMENTARY SCHOOL
Total Enrollment: 24
Grade Level/Section: Two-Mango

NAME OF CHILD GENDER HAND FEEDING

DEWORMED
TOOTH
BRUSHING REMARKS
ACTION
MALE M F WASHING DONE
DONE
TAKEN

1. ABION, Joshua A.     

2. ANDRES, Migz M.     

3. ASIM, Jerico B.     

4. BEBERO, Migz P.     

5. BORJA, Nikko A.     

6. CAÑAVERAL, Migz B.     

7. CORTEZ, John Rey N.     

8. CORTEZ, John Vincent C.     

9. CORTEZ, Robert I.     

10. DELIÑA, John Vincent N.     

11. DISLATE, Rhenz Benjamin M.     

12. FLORIANO, John Robert I.     

13. GREJALVO, Jacob B.     

14. HUERNO, Ace B.     

15. LUMIBAO, Tristan John A.     

FEMALE
1. AREVALO, MARICAR O.     

2. DISLATE, Rhianne Bhelle M.     

3. GARCELLANOSA, Bettina Jane R.     

4. GRIJALVO, Francheska SP.     

5. ISRAEL, Janice J.     

6. REYES, Eliza B.     

7. SABERON, Joy B.     
8. TOMOTORGO, Jocelyn R.     

9. VILLAFLOR, Tricia Mae P.     

Prepared by

ANITA M. MANISCAN
Adviser

Noted:

ALVIN G. VALENCIA
School Principal-I