SCVT

Let's Get Back to Normal, Let's Get Vaccinated

COVID-19 VACCINE REGISTRATION

Frontline Workers Frontline workers in health facilities both national and local, private and public. health professionals and non-professionals like students, nursing aides, janitors, barangay health workers etc.

Total Registrants 41,000

ID NUMBERS:

Category:

Valid ID to Present on Site: *

IDNumber:

PhilHealth Number: (Optional)

PWD Number: (Optional)

BASIC INFO:

LastName: *

FirstName: *

MiddleName:

Suffix:

Mobile No: *

Address:

Barangay: *

Contact No:

Gender:

BirthDate: *

Civil Status:

PWD

Indigenous Member

EMPLOYMENT INFO:

Employment Status:

Profession:

If Profession is Others:

Employer Name:

Employer Contact number:

Address of Employer:

Province of Employer:

ALLERGIES INFO:

Drug Allergy

Food Allergy

Insect Allergy

Latex Allergy

Mold Allergy

Pet Allergy

Pollen Allergy

COMMORBIDITIES INFO:

Hypertension

Heart Disease

Kidney Disease

Diabetes Mellitus

Bronchial Asthma

Immunodeficiency Status

Cancer

COVID-19 EXPOSURE HISTORY:

Contact with covid?

Had a history with Covid?:

If yes, please specify the date:

COVID CLASSIFICATION:

DO YOU WANT TO GET VACCINATED?:

Click Register to Save Info

Upload ID

Successfully Registered

Your Registration Number is LAG-000^*

^*It is not your queuing number. This will be used at the Vaccination Site for faster accessing your record.

A Confirmation Message has been sent to your mobile number .

Please wait for the Text Message for the Schedule and Location of your Vaccination.

For questions and clarifications please contact the City Information Technology Office at
049-530-0015 local 2301 or leave a message in their
Official Facebook Page at www.facebook.com/CITOSantaRosaCity.

THANK YOU! LETSGETVAC!

ATTENTION!

The name JUAN DELA CRUZ
with birthdate of MAY 27, 2021
is already registered in our system.

Please contact the City Information Technology Office at
049-530-0015 local 2301 or leave a message in their Official Facebook Page at www.facebook.com/CITOSantaRosa to verify this record.

ATTENTION!

Sa mga 18 years old pababa.

Nakabukas na po ang pagpaparehistro para sa edad may 5 - 11 years old at edad 12 pataas, maaring pumili ng category para sa 12-17/5-11 upang makapag patuloy sa pag rerehistro

Maaring maghintay na lamang po ng Announcement sa nakatakdang petsa ng inyong bakunahan

Para sa karagdagang impormasyon, please contact the City Information Technology Office at
049-530-0015 local 2302 or leave a message in their Official Facebook Page at www.facebook.com/CITOSantaRosa.

ATTENTION!

Hindi po binabakunahan ang may mga edad na 5-anyos pababa.
Please contact the City Information Technology Office at
049-530-0015 local 2301 or leave a message in their Official Facebook Page at www.facebook.com/CITOSantaRosa to verify this record.

SELECT YOUR CATEGORY CLASSIFICATION

HEALTH WORKERS and OFWs • Health workers in health facilities both national and local, private and public
• Overseas Filipino Workers for deployment within the next 4 months
• Students from Medical and Allied Health Courses
• Immediate family members of health workers

Senior Citizen • Senior citizens aged 60 years old and above

PERSONS WITH COMORBIDITIES and PWDs • Persons with comorbidities including PWDs

Frontline Personnel • Private sector workers who work outside their homes
• Employees in government agencies and instrumentalities, including
government-owned or controlled corporations (GOCCs) and local government units
• Informal sector workers and self-employed who work outside their homes and those working in private households

Indigent Population • Poor population based on the NHTS-PR or other verification mechanisms of the local government

Rest of the Filipino Population Rest of the Filipino Population not otherwise included in the above groups(PNA).

Category for 5 - 11 years old `For Registration Only`

Pediatric A3
Age 5-11 with comorbidities including PWDs

Pediatric C
Age 5-11 Rest of the Pediatric Population

Category for 12 - 17 years old

Pediatric A3
Age 12-17 with comorbidities including PWDs

Pediatric C
Age 12-17 Rest of the Pediatric Population

Other
Government
Workers Other Government Workers.

Other Essential
Workers Other Essential Workers.

Socio-demographic groups Socio-demographic groups at higher risk other than senior citizens & indigenous people.

Overseas Filipino
Workers Overseas Filipino Workers.

Other Remaining
Workers Other Remaining Workers.

Expanded Categories

Expanded A1
OFW leaving within 4 months, Household members of Health Workers and additional A1

Expanded A3
Pregnant Women

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Please contact the City Information Technology Office at
049-530-0015 local 2301 or leave a message in their Official Facebook Page at www.facebook.com/CITOSantaRosa to verify this record.

Taken

Tag number for this barangay is already taken.

Please check the tag number and barangay or contact our System Administrator at local 2302

System Administrator

Disclaimer

By filling-up this form, it is mandatory to declare any illness and provide information that will aid in the vaccination process. Be sure that the information you give is accurate and complete. All the information submitted shall be encrypted, and strictly used only in compliance to Philippine law, guidelines, and ordinances.

By signing this form you agree that all information will be used for the purpose of vaccination and related health protocols, in accordance with the Data Privacy Act of 2012.