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JDSES Online Parents Registration: Pangalan (Apelyido, Ngalan, Initial)

This document is a registration form for parents to receive online modules from JDSES and provide contact tracing information. It collects the parent's name, which modules they need for their child's grade level, two phone numbers, address, and health screening questions about whether they currently feel well and have symptoms like fever or cough.

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Jane Angela Padilla Cadiente
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59 views4 pages

JDSES Online Parents Registration: Pangalan (Apelyido, Ngalan, Initial)

This document is a registration form for parents to receive online modules from JDSES and provide contact tracing information. It collects the parent's name, which modules they need for their child's grade level, two phone numbers, address, and health screening questions about whether they currently feel well and have symptoms like fever or cough.

Uploaded by

Jane Angela Padilla Cadiente
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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JDSES Online Parents Registration

Module Dstribution Log Form for Parents and Contract Tracing

1.Name (Surname, First Name, Middle Initial)


Pangalan(Apelyido, Ngalan, Initial)

______________________________________________________________

2.Modules to get (Mga kuhaon nga modules)


Kinder
Grade One
Grade Two
Grade Three
Grade Four
Grade Five
Grade Six
3. Cellphone No. 1 (Palihug ibutang ang tama nga number sa imong cellphone)

________________________________
4. Cellphone No. 2 (Palihug ibutang ang tama nga number sa imong cellphone)

________________________________
5. Address (Pinuy-anan)

6. Are you feeling well now? (Maayo ba ang imung pamati karon?)

Yes No Maybe

Others: ____________________________________________________________
7. Do you have fever? (Adunay ka bay lagnat?)

Yes No Maybe

Others: ____________________________________________________________
8. Do you have cough? (Aduna ka bay ubo?)

Yes No Maybe

Others: ____________________________________________________________
JDSES Online Parents Registration
Module Dstribution Log Form for Parents and Contract Tracing

1.Name (Surname, First Name, Middle Initial)


Pangalan(Apelyido, Ngalan, Initial)

______________________________________________________________

2.Modules to get (Mga kuhaon nga modules)


Kinder
Grade One
Grade Two
Grade Three
Grade Four
Grade Five
Grade Six
3. Cellphone No. 1 (Palihug ibutang ang tama nga number sa imong cellphone)

________________________________
4. Cellphone No. 2 (Palihug ibutang ang tama nga number sa imong cellphone)

________________________________
5. Address (Pinuy-anan)

6. Are you feeling well now? (Maayo ba ang imung pamati karon?)

Yes No Maybe

Others: ____________________________________________________________
7. Do you have fever? (Adunay ka bay lagnat?)

Yes No Maybe

Others: ____________________________________________________________
8. Do you have cough? (Aduna ka bay ubo?)

Yes No Maybe

Others: ____________________________________________________________
JDSES Online Parents Registration
Module Dstribution Log Form for Parents and Contract Tracing

1.Name (Surname, First Name, Middle Initial)


Pangalan(Apelyido, Ngalan, Initial)

______________________________________________________________

2.Modules to get (Mga kuhaon nga modules)


Kinder
Grade One
Grade Two
Grade Three
Grade Four
Grade Five
Grade Six
3. Cellphone No. 1 (Palihug ibutang ang tama nga number sa imong cellphone)

________________________________
4. Cellphone No. 2 (Palihug ibutang ang tama nga number sa imong cellphone)

________________________________
5. Address (Pinuy-anan)

6. Are you feeling well now? (Maayo ba ang imung pamati karon?)

Yes No Maybe

Others: ____________________________________________________________
7. Do you have fever? (Adunay ka bay lagnat?)

Yes No Maybe

Others: ____________________________________________________________
8. Do you have cough? (Aduna ka bay ubo?)

Yes No Maybe

Others: ____________________________________________________________
JDSES Online Parents Registration
Module Dstribution Log Form for Parents and Contract Tracing

1.Name (Surname, First Name, Middle Initial)


Pangalan(Apelyido, Ngalan, Initial)

______________________________________________________________

2.Modules to get (Mga kuhaon nga modules)


Kinder
Grade One
Grade Two
Grade Three
Grade Four
Grade Five
Grade Six
3. Cellphone No. 1 (Palihug ibutang ang tama nga number sa imong cellphone)

________________________________
4. Cellphone No. 2 (Palihug ibutang ang tama nga number sa imong cellphone)

________________________________
5. Address (Pinuy-anan)

6. Are you feeling well now? (Maayo ba ang imung pamati karon?)

Yes No Maybe

Others: ____________________________________________________________
7. Do you have fever? (Adunay ka bay lagnat?)

Yes No Maybe

Others: ____________________________________________________________
8. Do you have cough? (Aduna ka bay ubo?)

Yes No Maybe

Others: ____________________________________________________________

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