eCabuyao | CABVax

Let's GO CabVax! MAGpabakuna na! ... Ang CORONA ay KAYANG KAYA! Basta't TAYO ay SAMA-SAMA! ...

PRE-REGISTRATION FORM

IMPORTANTENG MENSAHE:
18 taong gulang pataas lamang ang bibigyan ng pagbabakuna sa naka-iskedyul na petsa.

Kung kayo ay may mga sumusunod na karamdaman (Cancer, Leukemia, with history of allergic reactions, at iba pang malubhang karamdaman) kayo po ay hindi pinahihintulutan na mabakunahan maliban na lamang kung kayo ay bibigyan ng Medical Clearance o pahintulot ng inyong doctor.

Last Name *

First Name *

Middle Name *Put "NA" If not Applicable

Suffix(Jr., Sr., etc.)

Date Of Birth (mm/dd/yyyy)

Civil Status *

Sex *

Contact Number *

Barangay *

Home Adrress (e.g. street, block, lot, unit)

(Additional Information): -Note : Put "NA" If not Applicable

Category *

ID Category *

ID Number *

PhilHealth ID *

Employee Status *

Profession *

Specify Profession *

Employer Name *

Employer Contact *

Employer Adrress (e.g. street, block, lot, unit, barangay, city)

With Allergy *

YES NO

Type of Allergy *

DRUGS FOOD INSECTS LATEX MOLD PET POLLEN OTHERS

With Comorbidities *

YES NO

(If YES, Please indicate your comorbidities) *

HYPERTENSION HEART DISEASE KIDNEY DISEASE DIABETES MELLITUS BRONCHIAL ASTHMA IMMUNODEFICIENCY STATE CANCER OTHERS

Provide Electronic Informed Consent? (Yes/No) *

YES NO

By submitting this form, you confirm that you have read and agree to the E-CABS Privacy and Terms

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Privacy and Terms

Last updated Sept. 07, 2020

The City Government of Cabuyao respects the privacy of our users and wants you to understand how we collect, use, and share your personal information. This Privacy Policy covers our data processing practices and describes your data privacy rights under Republic Act No. 10173 known as the Data Privacy Act of 2012.

COLLECTION OF YOUR INFORMATION

We collect the following personal information from you when you sign up electronically submit to us your inquiries or requests in relation to Cabuyao City COVID-19 Vaccine Pre-Registration program:

Personal Data

Demographic and other personally identifiable information that you voluntarily give to us when choosing to participate in various activities related to the Application.

For Personal

Name
Age
Gender
Civil Status
Date of Birth
Contact Information
Email Address
Address
Device Location
Mac Address

SHARING OF INFORMATION

You voluntarily and freely consent to the collection and sharing of personal data such as name, postal address, contact information, and health information as required by the Republic Act No. 11469 known as the “Bayanihan to Heal as One Act”.

DATA PRIVACY RIGHTS

Under the DPA, we are committed to upholding your rights concerning your personal information. You have the right to correct or modify or erase your personal information from our systems, databases, and processes.

CONTACT US

If you have questions or comments about this Privacy Policy, please contact our team:

E-Cabs Software Developers Team

enterprise.cabuyao@gmail.com

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