MUNICIPAL SOCIAL WELFARE AND DEVELOPMENT

SUPPLEMENTARY FEEDING PROGRAM

_____ CYCLE
DAYCARE CENTER LEVEL
NAME OF CHILD DEVELOPMENT WORKER:__________________________________________ ADDRESS:__________________________________
NAME OF CHILD DEVELOPMENT CENTER:___________________________________________ CONTACT NUMBER:__________________________

NAME OF PARENT NAME OF CHILDREN BIRTHDAY AFTER THEE MONTHS AFTER SIX MONTHS
(mm/dd/yyyy)
NO. (LAST NAME, FIRST LAST NAME FIRST NAME MIDDLE NAME SEX Date of Age Weight Height(c
Nutritional Status
Date of Age Weight Height(c
Nutritional Status REMARKS
Weight Height for Weight Height for
NAME, MIDDLE NAME) Weighing (mos.) (kg.) m.)
for age age Weighing (mos.) (kg.) m.)
for age age

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NAME OF PARENT NAME OF CHILDREN BIRTHDAY AFTER THEE MONTHS AFTER SIX MONTHS
(mm/dd/yyyy)
NO. (LAST NAME, FIRST LAST NAME FIRST NAME MIDDLE NAME SEX Date of Age Weight Height(c Nutritional Status Date of Age Weight Height(c Nutritional Status REMARKS
NAME, MIDDLE NAME) Weighing (mos.) (kg.) m.)
Weight Height for Weighing (mos.) (kg.) m.)
Weight Height for
for age age for age age

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PREPARED BY:
___________________________________________________ ___________________________________
CHILD DEVELOPMENT WORKER DATE
 MUNICIPAL SOCIAL WELFARE AND DEVELOPMENT
SUPPLEMENTARY FEEDING PROGRAM
_____ CYCLE
DAYCARE CENTER LEVEL
NAME OF CHILD DEVELOPMENT WORKER:__________________________________________ ADDRESS:__________________________________
NAME OF CHILD DEVELOPMENT CENTER:___________________________________________ CONTACT NUMBER:__________________________

NAME OF PARENT NAME OF CHILDREN BIRTHDAY UPON ENTRY

(mm/dd/yyyy)
NO. (LAST NAME, FIRST NAME, LAST NAME FIRST NAME MIDDLE NAME SEX Date of Age Weight Height(c
Nutritional Status REMARKS
Weight Height for
MIDDLE NAME) Weighing (mos.) (kg.) m.)
for age age

1 RHODA BATYAD BERRY ALSIYANG SIGMON BERRY M 3/11/2016 08/19/20 15 102

2 MAELLA CAMPILIS PADAN AMELING LYNDY MAE PADAN F 9/11/2017 13 95
3 CHERUBIM BUSAL BACULI BACULI SHELTON BACULI M 01/16/16 20 118
4 WILFREDO BULLAYAO BASIAG BASIAG GENIUS INTEL BASIAG M 11/20/16 20 103
5 LAURIEJOY OCLIT ITONG BATTIKIN BLAIN RUTH ITONG F 09/14/18 21 124
6 SILMA OILAO LIMTO BERRY DIANNY QUINN LIMTO F 03/29/16 15 99
7 SILMA OILAO LIMTO BERRY DAYANA LIMTO F 4/3/2018 10 86
8 MAE-ANN DATOL GIWAGIW OSDEG JOASH RAPHA GIWAGIW M 05/19/17 13 99
9 HARLEY QUIN AYANGDO PINATED CALITON DRAJIC REY AYANGDO PINATED M 03/17/18 10 93
10 ROSALINE AGEN PINATED DOCASAO AMIRAH PINATED F 12/15/15 20 100
11 JONIE PICOY POS-AN DOLI-IS MAJIKA POS-AN F 2/9/2019 6 69
12 TINA LUCES TALYOD DOMONGIT JOANNA FAITH TALYOD F 4/3/2016 15 105
13 TINA LUCES TALYOD DOMONGIT JATHNIEL TALYOD M 8/10/2017 14 100
14 APRIL DICKPUS DICKLY DUGUIANG DRIANA DICKLY F 5/1/2017 15 99
15 ELVIRA CAMUYOT DOCASAO DUPLI VINCE CARTER DOCASAO M 12/13/15 13 100
16 FAITH OSDEG BUSAL FAKAT EROS OWEN BUSAL M 10/17/17 14 90
17 RHODA LABASLI LONG-OD GAMONGAN MOANA MARIE LONG-OD F 07/23/17 10 96
18 MICHELLE AYANGDO GAYBON GAYBON DYLAN JAY GAYBON M 3/10/2018 15 99
19 TRINITY PATACLANG BALANGUE LAPITAN TRISTAN BALANGUE M 05/31/17 16 100
20 JAMAICA SAGALON MINTON LONG-OD SHYRA MINTON F 2/1/2016 13 105
21 MERRIAM DIWAG MONTANO MALING KIAN MONTANO M 05/19/17 12 96
22 MAE-ANN DATOL GIWAGIW OSDEG JOANA GALE GIWAGIW F 12/22/15 14 100
23 MAE LYNNE MACABIO GALLAMOY OYANDO AZARIAH MCKATE GALLAMOY F 09/23/16 13 96
24 PATTY DAINE SACLAG AO-WAT PARTIDO ALDAINE KLEA SACLAG AO-WAT F 11/16/17 13 94
25 CLAIREEN SAGASAG DUGUIANG SACLAG SYDNEY CLAINE DUGUIANG M 01/20/16 14 100
 26 PRILEY DUGUIANG REALCE SUYAO LUIGI REALCE M 09/26/16 14 102
BIRTHDAY UPON ENTRY
(mm/dd/yyyy)
NO. LAST NAME FIRST NAME MIDDLE NAME Date of Age Weight Height(c Nutritional Status REMARKS
Weighing (mos.) (kg.) m.)
Weight Height for
for age age

27 PRILEY DUGUIANG REALCE SUYAO ATHENA REALCE F 12/18/17 15 100

28 JIMAYMA BANYA -AO DINANAS TALYOD TEDRICK DINANAS M 11/26/16 14 88
29 JIMAYMA BANYA -AO DINANAS TALYOD SHANAYA GRACE DINANAS F 11/24/18 12 100
30 JUDYBELLE NGAYA-AN CAMPUS NGOLAB CHARYDELLE CAMPUS F 03/13/16 14 100
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PREPARED BY:
___________________________________________________ ___________________________________
CHILD DEVELOPMENT WORKER DATE