Page 48 - GSCS PUPIL HANDBOOK
P. 48

Gonzaga South Central School
                                     Smart, Gonzaga, Cagayan



                                          CLINIC PASS



                                                           Date: _________ Time-In: _______

        Name of the Student: _______________________________________________________________________

        Teacher: __________________________________________________________________________________

        Complaint: ________________________________________________________________________________

        Action Taken: _____________________________________________________________________________



        Advised to:

        (   ) go home

        (   ) return to the class



        _______________________________            ___________________________________


        Signature Over Printed Name of the Adviser   Signature Over Printed Name of the Clinic Teacher

























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