Consent Form
Consent Form
Consent Form
Nagpapahibaru iton Deped magkakamyda hin: Nagpapahibaru iton Deped magkakamyda hin:
COVID 19 Vaccination hiton __________________ COVID 19 Vaccination hiton __________________
dida hit sulod hiton eskwlahan hiton aga. dida hit sulod hiton eskwlahan hiton aga.
Alayon pag tseke iton box: Alayon pag tseke iton box:
Natuyang ak Natuyang ak
Dire ak Natuyang : Ano nga rason? _____________ Dire ak Natuyang : Ano nga rason? _____________
_________________________________________ _________________________________________
Remarks: Remarks:
………………………………………………………………………………………….. ……………………………………………………………………………………………
Nagpapahibaru iton Deped magkakamyda hin: Nagpapahibaru iton Deped magkakamyda hin:
COVID 19 Vaccination hiton __________________ COVID 19 Vaccination hiton __________________
dida hit sulod hiton eskwlahan hiton aga. dida hit sulod hiton eskwlahan hiton aga.
Alayon pag tseke iton box: Alayon pag tseke iton box:
Natuyang ak Natuyang ak
Dire ak Natuyang : Ano nga rason? _____________ Dire ak Natuyang : Ano nga rason? _____________
_________________________________________ _________________________________________
Remarks: Remarks: