Please fill out the following form for contact tracing purposes.
Name
*
First
Last
Address
*
Phone
*
Privacy
*
I hereby authorize
Pathcutters Phils. Inc.
to collect and process the data I have provided herein and forward the same to the local government of Bacolod City and the Department of Health to be utilized in COVID-19 contact tracing efforts.
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Time
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:
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