• Daily Symptoms Checklist

  • Date
     - -
  • By signing this form, I declare that the information I have given is true, complete, and correct. I understand that the failure to answer any questions or giving a false answer can be penalized in accordance with the law and will be considered as grounds for my removal to the Iskolar ni Juan program.

  • Do you have any of the following symptoms?
  • I do not have any of the symptoms stated above
  • Clear
  • Should be Empty:
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