Baliwag Covid-19 Booster Registration Form

If you lost your vaccination card, please message this page “Baliwag ICT” Page to assist you to retrieve your vaccination card.

If camera doesnt work, click this link and follow the steps.

Firstname
Middlename
Lastname
Contact No.
Birthdate
Sex
First Dose Details
Vaccine Brand
Date of Vaccination
Batch No.
Lot No.
Vaccinator Name
Vaccination Facility
Second Dose Details
Vaccine Brand
Date of Vaccination
Batch No.
Lot No.
Vaccinator Name
Vaccination Facility
Sector
Note:

Heterologous - refers to the administration of a COVID-19 vaccine of a different brand from the vaccine that was used to complete the primary vaccine series.

Homologous - refers to the administration of a COVID-19 vaccine of the same brand from the vaccine that was used to complete the primary vaccine series.

1st Choice
2nd Choice
3rd Choice

Drop/Click here to upload your PRC ID.

If PRC ID is not available,

please upload any valid/primary ID.

Remarks:

Covid-19 Booster Vaccine is not mandatory.