ANNEX C

Form 1
National School Deworming Day
Deworming Checklist

Province/Division: SOUTH COTABATO District: SURALLAH NORTH 1

Name of School: LIBERTAD NATIONAL HIGH SCHOOL Sch. Address: Surallah, South Cotabato
Grade Level and Section: G-12 SMAW B Total Enrolment: 31
Pls. check appropriate boxes
Gende Handwas No
Name of Pupils h Feedin Deworme
Toothbrus
4P' n
r h Remarks Action taken
g d s
4P'
Male M F ing done
ing done s
1 ALEGRE, REYMARK O. /       /   /      
2 ALONSAGA, JADE O. /       /   /      
3 ANDAL,JAY-AR A. /       /   /    
4 AYONG, DONALD C. /       /   /      
5 BACERRA, JEMAR E. /       /   /      
6 BUBAN, JHOMAR B. /       /   /      
7 BUBURAN, NILO L. /       /     /    
8 CALIBAYAN, MICHAEL C. /       /     /    
9 CAÑA, JOGIE S. /       /   /      
1
CASTOR, COE P. / / /
0              
1
DELECTOR,JOSHUA EARL D. / / /
1              
1
DELLOMES, MARLON D. / / /
2              
1
DELOS REYES, JUNVIEL P. / / /
3              
1
DEVECAIS, JOHN PAUL T. / / /
4              
1
FERNANDEZ, REY JR. F. / / /
5              
1
GAPE, JUNELL F. / /   /
6            
1
HAGUISAN, JERIC REY B. / / /
7              
1 HAGUISAN, REZHAR JONES
B. / / /
8              
1
JUARIO, JAMESON E. / / /
9              
2
LOPEZ, ARJAY C. / / /
0              
2
MAGNO, RYN D. / / /
1              
2
PAEZ, KRECOL P. / / /
2              
2
PAGUTAO, JOVEN E. / / /
3              
2
PUEBLO, SEAN MARK M. / / /
4              
2
SALGADO, DEXTER M. / / /
5              
2 SAMPANE, UDJEN M. /       /     /    
6
2
SOLOGASTOA, GERSON M. / / /
7              
2
TENDENILLA, ROMER A. / / /
8              
2
TOLENTINO, JOHN REY S. / / /
9              
Female                    
1 GARRIDO, HONYEN B.   /     /     /    
2 MOLINA, JENNEFER A.   /     /   /      
*Use another page if necessary.

Accomplished by: Noted:

ROMEL B. GONZAGA ENRIQUE U. DELA CRUZ JR.
Class Adviser Pricipal/Head Teacher/TIC
Date Accomplished: 07-10-2018

GRADE 12 SMAW B
S.Y.2018-2019
Male GRADE & SECTION SCHOOL YEAR REMARKS
1 ALEGRE, REYMARK O. GRADE 11 ELECTRODE S.Y. 2017-2018
2 ALONSAGA, JADE O. GRADE 11 ELECTRODE S.Y. 2017-2018
3 ANDAL,JAY-AR A. GRADE 11 ELECTRODE S.Y. 2017-2018
4 AYONG, DONALD C. GRADE 11 ELECTRODE S.Y. 2017-2018
5 BACERRA, JEMAR E. GRADE 11 ELECTRODE S.Y. 2017-2018
6 BUBAN, JHOMAR B. GRADE 11 ELECTRODE S.Y. 2017-2018
7 BUBURAN, NILO L. GRADE 11 ELECTRODE S.Y. 2017-2018
8 CALIBAYAN, MICHAEL C. GRADE 11 ELECTRODE S.Y. 2017-2018
9 CAÑA, JOGIE S. GRADE 11 ELECTRODE S.Y. 2017-2018
1 GRADE 11 ELECTRODE S.Y. 2017-2018
CASTOR, COE P.
0
1
DELECTOR,JOSHUA EARL D.
1
1 GRADE 11 ELECTRODE S.Y. 2017-2018
DELLOMES, MARLON D.
2
1 GRADE 11 ELECTRODE S.Y. 2017-2018
DELOS REYES, JUNVIEL P.
3
1 GRADE 11 ELECTRODE S.Y. 2017-2018
DEVECAIS, JOHN PAUL T.
4
1 GRADE 11 ELECTRODE S.Y. 2017-2018
FERNANDEZ, REY JR. F.
5
1 GRADE 11 ELECTRODE S.Y. 2017-2018
GAPE, JUNELL F.
6
1 GRADE 11 AMPERAGE S.Y. 2017-2018
HAGUISAN, JERIC REY B.
7
1 HAGUISAN, REZHAR JONES B. GRADE 11 AMPERAGE S.Y. 2017-2018
 8
1 GRADE 11 AMPERAGE S.Y. 2017-2018
JUARIO, JAMESON E.
9
2 GRADE 11 AMPERAGE S.Y. 2017-2018
LOPEZ, ARJAY C.
0
2 GRADE 11 AMPERAGE S.Y. 2017-2018
MAGNO, RYN D.
1
2 GRADE 11 AMPERAGE S.Y. 2017-2018
PAEZ, KRECOL P.
2
2 GRADE 11 AMPERAGE S.Y. 2017-2018
PAGUTAO, JOVEN E.
3
2 GRADE 11 AMPERAGE S.Y. 2017-2018
PUEBLO, SEAN MARK M.
4
2 GRADE 11 AMPERAGE S.Y. 2017-2018
SALGADO, DEXTER M.
5
2 GRADE 11 AMPERAGE S.Y. 2017-2018
SAMPANE, UDJEN M.
6
2 GRADE 11 AMPERAGE S.Y. 2017-2018
SOLOGASTOA, GERSON M.
7
2 GRADE 11 AMPERAGE S.Y. 2017-2018
TENDENILLA, ROMER A.
8
2 GRADE 11 AMPERAGE S.Y. 2017-2018
TOLENTINO, JOHN REY S.
9
Female
1 GARRIDO, HONYEN B. GRADE 11 ELECTRODE S.Y. 2017-2018
2 MOLINA, JENNEFER A. GRADE 11 AMPERAGE S.Y. 2017-2018

ROMEL B. GONZAGA
ADVISER