QUESTIONS

1. Will you permit your child to attend the limited face-to-face LABORATORY CLASSES
if it is going to be implemented?

YES NO

2. Explain your answer above. You may use Tagalog/ Filipino in explaining your choice.
NAME of PARENT/ GUARDIAN (format: Surname, Given Name Middle Initial)

NAME of CLDHEI STUDENT (format: Surname, Given Name Middle Initial)

YEAR & Section of CLDHEI STUDENT (example: BSN 1A)

3. Are you willing to register your child and pay for their PhilHealth insurance?
OBJECTIVE: This survey intends to know the consensus of the 1st year, 2nd year, & 3rd students
and their parents/ guardians regarding the conduct of laboratory classes in a LIMITED face-
YES NO My child is already my
to-face set-up. The data that will be gathered in this survey will help the school in planning
beneficiary in Philhealth
and deciding on the matter. Full cooperation is expected on all 1st year, 2nd year, & 3rd
students and their parents/guardians.

DIRECTIONS: Please answer the questions on the next panel and make your child upload a
photo or scanned copy of this survey on the google drive folder given to them.

Parent’s/ Guardian’s Signature Date

over Printed Name