Parent Consent Kontra Bulate

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Parents Consent

Sa Kinauukulan:

______________
Petsa

Pinapayagan ko si __________________________, Baitang/Pangkat_________________ na painumin ng


gamot pampurga (Albendazole) dalawang beses sa isang taon ( Hulyo
at
Enero ) ng Gurong
Tagapayo/Clinic Teacher/Health Worker.
Lagyan ng Task ang kahon
4Ps Member
Non 4ps Member
_____________________________________
Pangalan at Lagda ng Magulang/ Tagapagalaga

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