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Republic of the Philippines

Department of Education
REGION IX, ZAMBOANGA PENINSULA
SCHOOLS DIVISION OF ZAMBOANGA CITY
NATIONAL DEWORMING MONTH

PROVINCE/CITY: _________________________________________________ TOTAL ENROLLMENT:__________________________


DIVISION:_________________________________________________________ GRADE & SECTION:______________________________
DISTRICT:_________________________________________________________
SCHOOL: __________________________________________________________
SCHOOL ADDRESS: ________________________________________________
NO. NAME OF STUDENT GENDER HAND FEEDING DEWORMED TOOTH REMARKS
WASHING BRUSHING
MALE FEMALE
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ACCOMLISHED BY: NOTED BY:

_________________________________________ ________________________________________
CLASS ADVISER SCHOOL HEAD

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