1. Republic of the Philippines
Department of Education
Schools Division of Quezon City
COVID-19 MASTERLIST FOR 12-17 YEARS OLD
School Name: Region: _____NCR_____
Division: _Quezon City_________________ Province/City: METRO MANILA
Name
(Surname,First, M.I) Age
Date
of
Birth
Gender Grade
Level
Parent's/
Guardian's Name
Contact No.
Of Parents/
Guardian
Parent's
Consent Comorbidity Deferred
Reasons
for
Deferral
Vaccinated
Not yet
Vaccinated
Brgy. Address