Health Declaration Form



De La Salle-College of Saint Benilde (DLS-CSB) is one with the global community in preventing the spread of the COVID-19 virus. We are requiring our visitors to fill-out this Health Declaration Form as part of our regular Campus Access Controls.

I hereby authorize DLS-CSB, to collect and process the data indicated herein for the purpose of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012, and that I am required by RA 11469, Bayanihan to Heal as One Act, to provide truthful information.