Resurrection of Our Lord Parish Resurrection of Our Lord Parish Resurrection of Our Lord Parish

COVID19 Alert Response System COVID19 Alert Response System COVID19 Alert Response System
(ROLP CARES) (ROLP CARES) (ROLP CARES)

Name: ___________________________ Name: ___________________________ Name: ___________________________

Address(Enclave or Community Only): Address(Enclave or Community Only): Address(Enclave or Community Only):
_________________________________ _________________________________ _________________________________
Contact No. : ______________________ Contact No. : ______________________ Contact No. : ______________________
Date of Visit to the Office: _____________ Date of Visit to the Office: _____________ Date of Visit to the Office: _____________
Time of Visit to the Office: _____________ Time of Visit to the Office: _____________ Time of Visit to the Office: _____________
Purpose/Person Visiting: Purpose/Person Visiting: Purpose/Person Visiting:
____________________________________ ____________________________________ ____________________________________
I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data
indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that
my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of
2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act, 2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act, 2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act,
to provide truthful information. to provide truthful information. to provide truthful information.

Signature: ______________________ Signature: ______________________ Signature: ______________________

Resurrection of Our Lord Parish Resurrection of Our Lord Parish Resurrection of Our Lord Parish
COVID19 Alert Response System COVID19 Alert Response System COVID19 Alert Response System
(ROLP CARES) (ROLP CARES) (ROLP CARES)

Name: ___________________________ Name: ___________________________ Name: ___________________________

Address(Enclave or Community Only): Address(Enclave or Community Only): Address(Enclave or Community Only):
_________________________________ _________________________________ _________________________________
Contact No. : ______________________ Contact No. : ______________________ Contact No. : ______________________
Date of Visit to the Office: _____________ Date of Visit to the Office: _____________ Date of Visit to the Office: _____________
Time of Visit to the Office: _____________ Time of Visit to the Office: _____________ Time of Visit to the Office: _____________
Purpose/Person Visiting: Purpose/Person Visiting: Purpose/Person Visiting:
____________________________________ ____________________________________ ____________________________________
I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data
indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that
my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of
2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act, 2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act, 2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act,
to provide truthful information. to provide truthful information. to provide truthful information.

Signature: ______________________ Signature: ______________________ Signature: ______________________

Resurrection of Our Lord Parish Resurrection of Our Lord Parish Resurrection of Our Lord Parish
COVID19 Alert Response System COVID19 Alert Response System COVID19 Alert Response System
(ROLP CARES) (ROLP CARES) (ROLP CARES)

Name: ___________________________ Name: ___________________________ Name: ___________________________

Address(Enclave or Community Only): Address(Enclave or Community Only): Address(Enclave or Community Only):
_________________________________ _________________________________ _________________________________
Contact No. : ______________________ Contact No. : ______________________ Contact No. : ______________________
Date of Visit to the Office: _____________ Date of Visit to the Office: _____________ Date of Visit to the Office: _____________
Time of Visit to the Office: _____________ Time of Visit to the Office: _____________ Time of Visit to the Office: _____________
Purpose/Person Visiting: Purpose/Person Visiting: Purpose/Person Visiting:
____________________________________ ____________________________________ ____________________________________
I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data
indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that
my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of
2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act, 2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act, 2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act,
to provide truthful information. to provide truthful information. to provide truthful information.

Signature: ______________________ Signature: ______________________ Signature: ______________________

Resurrection of Our Lord Parish Resurrection of Our Lord Parish Resurrection of Our Lord Parish
COVID19 Alert Response System COVID19 Alert Response System COVID19 Alert Response System
(ROLP CARES) (ROLP CARES) (ROLP CARES)

Name: ___________________________ Name: ___________________________ Name: ___________________________

Address(Enclave or Community Only): Address(Enclave or Community Only): Address(Enclave or Community Only):
_________________________________ _________________________________ _________________________________
Contact No. : ______________________ Contact No. : ______________________ Contact No. : ______________________
Date of Visit to the Office: _____________ Date of Visit to the Office: _____________ Date of Visit to the Office: _____________
Time of Visit to the Office: _____________ Time of Visit to the Office: _____________ Time of Visit to the Office: _____________
Purpose/Person Visiting: Purpose/Person Visiting: Purpose/Person Visiting:
____________________________________ ____________________________________ ____________________________________
I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data I hereby authorize RESURRECTION OF OUR LORD PARISH, to collect and process the data
indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that indicated herein for the purpose of effecting control for the COVID-19 infection. I understand that
my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of my personal information is protected by RA 10173 otherwise known as the Data Privacy Act of
2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act, 2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act, 2012, and that I am required by RA 11469 otherwise known as the Bayanihan to Heal as One Act,
to provide truthful information. to provide truthful information. to provide truthful information.

Signature: ______________________ Signature: ______________________ Signature: ______________________