Prepared by: Prepared by:

NOE S. PERALTA NOE S. PERALTA

Teacher III Teacher III
Checked by: Checked by:

MICHAEL G. DOMONDON MICHAEL G. DOMONDON

Head Teacher III Head Teacher III

Approved by: Approved by:

AISA C. DEL FIERRO AISA C. DEL FIERRO

Principal II Principal II

Signature Over Printed Name of Parent/Guardian

Signature Over Printed Name of Parent/Guardian

Date: _______________
Date: _______________

Prepared by: Prepared by:

NOE S. PERALTA NOE S. PERALTA

Teacher III Teacher III
Checked by: Checked by:

MICHAEL G. DOMONDON MICHAEL G. DOMONDON

Head Teacher III Head Teacher III

Approved by: Approved by:

AISA C. DEL FIERRO AISA C. DEL FIERRO

Principal II Principal II

Signature Over Printed Name of Parent/Guardian Signature Over Printed Name of Parent/Guardian

Date: _______________ Date: _______________