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Republic of the Philippines

Department of Education
Schools Division of Bacolod City
Rosario - San Juan Streets, Bacolod City

DEWORMING CONSENT OF SBFP BENEFICIARIES FOR S.Y. 2023-2024


SCHOOL: ______________________________________ DATE: _________________________

GRADE LEVEL: __________________________________

CONSENTED FOR SIGNATURE


NAME OF BENEFICIARIES NAME OF PARENT/GUARDIAN
DEWORMING (IF YES)
1. YES NO

SUBMITTED BY:

____NAME and SIGNATURE OF THE CLASS ADVISER______

Rosario–San Juan Streets, Bacolod City 6100 Telephone: (034) 704-2585


Facebook Page: https://www.facebook.com/bacolod.deped https://sites.google.com/site/depedbacolodcity
Email: bacolod.city@deped.gov.ph Website: bacolod.city@deped.gov.ph

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