St. Roch Chaplaincy, Arado, Palo, Leyte (COVID Register)

We humbly ask you fill-out the form TRUTHFULLY. Once contact tracing is implemented, these pieces of information will serve its purpose.

Date / Time of the Mass to be participated

Date

Time

Name

First

Middle

Last

Mobile

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email

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