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Department of Education

Region III
Division of Zambales
LAUIS NATIONAL HIGH SCHOOL
Candelaria, Zambales

Date:______________________________

Time:______________________________

Place:_________________________________

Name of Student:_______________________________

Purpose of Visit:
_________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Remarks/ Agreement: ___________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Visited by: Parent’s Signature:

____________________________ ____________________________

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