Contact Tracing Health Declaration Form Milk

Republic of the Philippines
Department of Education
Region III
Schools Division Office of Gapan City
STA. CRUZ ELEMENTARY SCHOOL
Health Declaration Sheet

Sta. Cruz Elementary School Date: ____11-16-2020_______
SCHOOL BASED FEEDING PROGRAM- MILK COMPONENT

Grade Temperatu
Name of Learner Name of Parent/Guardian Complete Address Contact No. Signature
Level/Section re
1 Salas, Caliex Kyrie E.
2 De Jesus, Jan Paulo A.
3 Trinidad, Thea H.
4 Gregorio, John Paul G
5 Gregorio, Nicole Ann R.
6 Gabriel, Jannel M.
7 Reyes, Aldrei Ervinson D.R.
8 Reyes, Trisha B.
9 Porciuncula, Eithan G.
10 Rivera, Jamell A.
11 Arambulo, Kriza Ann
Name of Learner Name of Parent/Guardian Grade Complete Address Contact No. Temperatu Signature
Address: Sta. Cruz, Gapan City

Telephone No.: (044) 958-7782
Email: 105330@deped.gov.ph
Region III
Level/Section re
12 Jimenez, Kirvy J.
13 Gaudario, Cris Naijel T.
14 Millanes, Mark Arvin L.
15 Navarro, Jhon Kenneth A.
16 Valenzuela, Sunshine E.
17 Gaudario, Niño R.
18 Abesamis, Kendryx Alwyn C.
19 Arcega, John Chris R.
20 De Jesus, Jan Rey A.
21 Gaudario, Nhaeythan Dave T.
22 Rivera, Emil James A.
23 Marcos, Jingky
24 Partoza, Claire S.
25 Matic, Malerie Claire C.
Grade Temperatu
Name of Learner Name of Parent/Guardian Complete Address Contact No. Signature
Level/Section re

Telephone No.: (044) 958-7782
Region III
26 Magbitang, Elajane E.
27 Marcelo, Juzmin Rhiane G.
28 Jimenez, Kenneth J.
29 Leabres, Railly G.
30 Malonzo, Angelo M.
31 Marcos, Ejay M.
32 Torres, John Benedick B.
33 Hernandez, Stephanie F.
34 De Guzman, Kyle Vincent F.
35 Vallejo, Sandi Jorge L.
36 Salvador, Lexine Jade L.
37 Arcilla, Prince Aaron A.
38 Jimenez, Radge Evo
39 Alvarez, Jan Paul C.
RECEIVING FORM
SCHOOL BASED FEEDING PROGRAM- MILK COMPONENT

Telephone No.: (044) 958-7782
Region III
SIGNATURE
Name of Learner Name of Parent/Guardian
11/09/2020 11/10/2020 11/11/2020 11/12/2020 11/13/2020
1 Salas, Caliex Kyrie E.
2 De Jesus, Jan Paulo A.
3 Trinidad, Thea H.
4 Gregorio, John Paul G
5 Gregorio, Nicole Ann R.
6 Gabriel, Jannel M.
7 Reyes, Aldrei Ervinson D.R.
8 Reyes, Trisha B.
9 Porciuncula, Eithan G.
10 Rivera, Jamell A.
11 Arambulo, Kriza Ann
12 Jimenez, Kirvy J.
13 Gaudario, Cris Naijel T.
14 Millanes, Mark Arvin L.
15 Navarro, Jhon Kenneth A.
16 Valenzuela, Sunshine E.
17 Gaudario, Niño R.
SIGNATURE
11/09/2020 11/10/2020 11/11/2020 11/12/2020 11/13/2020

Telephone No.: (044) 958-7782
Region III
18 Abesamis, Kendryx Alwyn C.

19 Arcega, John Chris R.
20 De Jesus, Jan Rey A.
21 Gaudario, Nhaeythan Dave T.
22 Rivera, Emil James A.
23 Marcos, Jingky
24 Partoza, Claire S.
25 Matic, Malerie Claire C.
26 Magbitang, Elajane E.
27 Marcelo, Juzmin Rhiane G.
28 Jimenez, Kenneth J.
29 Leabres, Railly G.
30 Malonzo, Angelo M.
31 Marcos, Ejay M.
32 Torres, John Benedick B.
33 Hernandez, Stephanie F.
34 De Guzman, Kyle Vincent F.
35 Vallejo, Sandi Jorge L.
36 Salvador, Lexine Jade L.
SIGNATURE
11/09/2020 11/10/2020 11/11/2020 11/12/2020 11/13/2020

Telephone No.: (044) 958-7782
Region III
37 Arcilla, Prince Aaron A.

38 Jimenez, Radge Evo
39 Alvarez, Jan Paul C.
40 Aragon, Greg T.
41 Azarcon,Vince Andrei G.
42 Cayanan,John Cedrick C.
43 Constantino,Keith Leonard E.
44 Dela Cruz,Sean Chamber M.
45 Garcia,Brayden Marius F.
46 Hojilla,Trevor Lorenzo L.
47 Lingat,Prince Nhomer P.
48 Miranda,Vince Edward C.
49 Adelante,Sabrina Leigh D.
50 Angeles,Creizsha Mae G.
51 Castillo,Athena Sophia Joy G.
52 Concepcion,Marian B.
53 Dela Cruz,Rhan C.
54 Deligiado,Jillian A.

Telephone No.: (044) 958-7782
Region III
55 Escubio,Mia Jean G.
56 Guantic,Hannah Mae P.
57 Gudao,Ashley Franzyl C.
58 Lungalong,Lhenie-Lyn L.
59 Henson,John Archie A.
60 Paganpan,Yjarniel D.
61 Perez,Mark B.
62 Policarpio,Jonathan C.
63 Quiambao,King Harley A.
64 Reyes,Mikhail Lexus P.
65 Reyes,Paul Andrei C.
66 Trinidad,Aiden Jacob H.
67 Velilia,Kyle Myron -
68 Villareal,Chris Neo S.
69 Jimenez,Jaymie Rose M.
70 Manalastas,Elle A.

Telephone No.: (044) 958-7782
Region III
71 Marcos,Marrian C.
72 Panganiban,Lexzy A.
73 Pangilinan,Edrelaine Shaine G.
74 Pangilinan,Princess Rianne P.
75 Pasco,Xia Jane B.
76 Ramos,Xynna Viel C.
77 Relox,Ingrid A.
78 Reyes,Jamaica R.
79 Villena,Khyrie Euriley A.
80 Ambal,Aron Rylee S.
81 Fernandez,Ceejay S.
82 Gagote,Sean Axel A.
83 Jimenez,Arjay P.
84 Lacsina,Limuel A.
85 Marcelo,Jonathan G.
86 Moneda,Givence G.

Telephone No.: (044) 958-7782
Region III
87 Montes,Kier Ashton T.
88 Salazar,Ryjan Karl P.
89 Santos,Kurt Aris A.
90 Villareal,Joshua DC
91 Aguilar,Rhoa Aiby D.
92 Arambulo,Zyldjian V.
93 Azarcon,Edray Marie E.
94 Cortes,Annekisha F.
95 De Andres,Kassandra Zoe L.
96 De Jesus,Stephanie Ann E.
Del Rosario,Princess Geraldine
97
M.
98 Fernando,Angel Joy A.
99 Garcia,Ryanne Juliana E.
100 Pangilinan,Jessica F.
101 Abesamis,Juan Dave, T.

Telephone No.: (044) 958-7782
Region III
102 Arambulo,Prince Jhon S.

103 Garces,Alekhine Yuri
104 Linsangan,Jan Rafael L.
105 Manalastas,Luis Aiden C.
106 Trinidad,Sairon G.
107 Usoria,Roel JR G.
108 Villanueva,Ace Jared F.
109 Alvarez,Chlow V.
110 Arambulo,Angeline F.
111 Bacani,Janine L.
112 Betuin,Maine Edzelle R.
113 De Villa, Janelle A.
114 Gamboa,Crystel Mae P.
115 Jimenez,Princess Cyreal J.
116 Mangulabnan,Bianca Aesha G.
117 Martin,Reynalyn A.

Telephone No.: (044) 958-7782
Region III
118 Pascual,Princess Jamaica C.

119 Trinidad,Princess Erica A.
120 Villareal,Lady Devinne L.
Prepared by:
CATHERINE L. FAJARDO
Feeding Focal Person
Noted:
CARMENCITA S. PINTOR
School Principal II

Telephone No.: (044) 958-7782
Region III

Telephone No.: (044) 958-7782
Region III
Sta. Cruz Elementary School Date: ___11-03-2020_______

Grade Level/Section: Grade Three - Mabini
Name of Learner Name of Parent/Guardian Age Complete Address Contact No. Temperature Signature
Male (Batch 2 – Green)
B8. Maghanoy, John Rhain M. Sta. Cruz Gapan, Nueva Ecija 0965-135-1599
B9. Mangulabnan, Steven Carl G. Sta. Cruz Gapan, Nueva Ecija 0905-652-7950
B10. Maño, Ace B. Sta. Cruz Gapan, Nueva Ecija 0965-227-5454
B11. Mariano, John Carlo A. Sta. Cruz Gapan, Nueva Ecija 0997-510-8042
B12. Navarro, John Kenneth A. Sta. Cruz Gapan, Nueva Ecija 0956-239-0335
B13. Pablo, Brian Dale C. Sta. Cruz Gapan, Nueva Ecija 0955-370-6319

Sta. Cruz Elementary School Date: ___11-03-2020________

Telephone No.: (044) 958-7782
Region III
Grade Level/Section: Grade Three - Mabini
Male (Batch 3 – Yellow)
B14. Pangilinan, Mark Felix M. Sta. Cruz Gapan, Nueva Ecija
B15. Postolero, Jakester E. Sta. Cruz Gapan, Nueva Ecija 0945-137-8098
B16. Reyes, John Carlo R. Sta. Cruz Gapan, Nueva Ecija 0918-708-2775
B17. Santos, Rafael JM. Sta. Cruz Gapan, Nueva Ecija 0906-634-4689
B18. Tisbe, Mark Angelo G. Sta. Cruz Gapan, Nueva Ecija 0953-243-5401
B19. Torres, John Lawrence M. Sta. Cruz Gapan, Nueva Ecija 0926-824-4297

Sta. Cruz Elementary School Date: ___11-03-2020___________
Grade Level/Section: Grade Three– Mabini

Telephone No.: (044) 958-7782
Region III
Female (Batch 1 – Blue)
G1. Bernabe, Jan Micah Maburak Gapan, Nueva Ecija 0953-153-1409
G2. Casabuena, Andrea M. Sta. Cruz Gapan, Nueva Ecija 0965-390-9453
G3. Cristobal, Lorainne Joyce N. Sta. Cruz Gapan, Nueva Ecija 0935-361-3942
G4. De Guzman, Jiecel S. Maburak Gapan, Nueva Ecija 0965-437-3256


Telephone No.: (044) 958-7782
Region III
Female (Batch 2 – Green)
G5. Gamboa, Jovy P. Maburak Gapan, Nueva Ecija 0955-391-2994
G6. Grospe, Bernadeth P. Sta. Cruz Gapan, Nueva Ecija 0965-765-4297
G7. Habinal, Akira Mae F. Sta. Cruz Gapan, Nueva Ecija 0997-311-6125
G8. Hernandez, Angelica M. Sta. Cruz Gapan, Nueva Ecija 0975-721-5769
G9. Loza, Rica Joy A. Sta. Cruz Gapan, Nueva Ecija 0916-999-5147


Telephone No.: (044) 958-7782
Region III
Female (Batch 3 – Yellow)
G10. Pacaigue, Riza T. Maburak Gapan, Nueva Ecija 0917-994-2334
G11. Pineda, Ana Joy A. Sta. Cruz Gapan, Nueva Ecija 0935-361-5675
G12. Sarmiento, Aprilyn Joy D. Sta. Cruz Gapan, Nueva Ecija 0907-490-8279
G13. Valenzuela, Sunshine E. Sta. Cruz Gapan, Nueva Ecija 0975-531-5392
G14. Viernes, Angel Lyn P. Sta. Cruz Gapan, Nueva Ecija 0965-227-5454

Telephone No.: (044) 958-7782

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Republic of the Philippines

Health Declaration Sheet

SCHOOL BASED FEEDING PROGRAM- MILK COMPONENT

Address: Sta. Cruz, Gapan City

Address: Sta. Cruz, Gapan City

Address: Sta. Cruz, Gapan City

Address: Sta. Cruz, Gapan City

18 Abesamis, Kendryx Alwyn C.

Address: Sta. Cruz, Gapan City

37 Arcilla, Prince Aaron A.

Address: Sta. Cruz, Gapan City

Address: Sta. Cruz, Gapan City

Address: Sta. Cruz, Gapan City

Address: Sta. Cruz, Gapan City

102 Arambulo,Prince Jhon S.

Address: Sta. Cruz, Gapan City

118 Pascual,Princess Jamaica C.

Address: Sta. Cruz, Gapan City

Health Declaration Sheet

Address: Sta. Cruz, Gapan City

Sta. Cruz Elementary School Date: ___11-03-2020_______

Health Declaration Sheet

Address: Sta. Cruz, Gapan City

Grade Level/Section: Grade Three - Mabini

Health Declaration Sheet

Address: Sta. Cruz, Gapan City

Health Declaration Sheet

Address: Sta. Cruz, Gapan City

Health Declaration Sheet

Address: Sta. Cruz, Gapan City

Grade Level/Section: Grade Three– Mabini

Address: Sta. Cruz, Gapan City

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Sta. Cruz Elementary School Date: _11-03-2020_____