1. Are you experiencing or did you have any of the following in the last 14 days? (Ikaw ba ay may nararanasan o nakakaranas ng mga sumusunod na sintomas sa nakaraang 14 na araw?)
I hereby authorize Brgy. Bel-air to gather, collect and use the data indicated herein for contact tracing purposes in effecting control of the COVID-19 transmission. I fully understand that the personal information provided is protected by RA10173 better known as the Data Privacy Act of 2012 and that this registration form will be destroyed 30 days from accomplishment date following protocols from the National Archives of the Philippines.