Municipality of Guimba COVID Vaccine Pre-Registration
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Name (Buong Pangalan) *
Barangay *
Address *
Cellphone Number *
Age (Edad) *
Person with Disability (PWD) *
Health Condition (Kondisyon ng kalusugan) *
List health condition if with comorbidity (Ilagay/Isulat ang Comorbidity kung mayroon)
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