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District: Rosario West Sub Office

School: Namuco Elem. School


Name of Student: ________________________________
Pinahihintulutan ko ang aking anak na mapurga sa paaralan ng mga doctor,nars o guro ng 2 beses sa
loob ng isang taon, taon-taon simula KINDER hanggang GRADE-6 ( 5-12years old)

SCHOOL GRADE 1ST SIGNATURE 2ND SIGNATURE


YEAR LEVEL DEWORMING OF DEWORMING OF
DEWORMER DEWORMER
2022-2023
2023-2024
2024-2025

________________________________
NAME AND SIGNATURE OF GUARDIAN

District: Rosario West Sub Office


School: Namuco Elem. School
Name of Student: ________________________________
(Pinahihintulutan ko ang aking anak na mapurga sa paaralan ng mga doctor,nars o guro ng 2 beses sa
loob ng isang taon, taon-taon simula KINDER hanggang GRADE-6 ( 5-12years old)

SCHOOL GRADE 1ST SIGNATURE 2ND SIGNATURE


YEAR LEVEL DEWORMING OF DEWORMING OF
DEWORMER DEWORMER
2022-2023
2023-2024
2024-2025

________________________________
NAME AND SIGNATURE OF GUARDIAN

District: Rosario West Sub Office


School: Namuco Elem. School
Name of Student: _______________________________
(Pinahihintulutan ko ang aking anak na mapurga sa paaralan ng mga doctor,nars o guro ng 2 besessa
loob ng isang taon, taon-taon simula KINDER hanggang GRADE-6 ( 5-12years old)

SCHOOL GRADE 1ST SIGNATURE 2ND SIGNATURE


YEAR LEVEL DEWORMING OF DEWORMING OF
DEWORMER DEWORMER
2022-2023
2023-2024
2024-2025

____________________________
NAME AND SIGNATURE OF GUARDIAN

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