You are on page 1of 1

DEPARTMENT OF EDUCATION

REGION III
Division of City of San Fernando
PAMPANGA HIGH SCHOOL
PHS Blvd., Brgy., Lourdes, City of San Fernando, Pampanga
Tel. No. (045) 961-4261 website:www.pampangahigh.school

PARENTAL CONSENT FORM1


(For Researches Conducted Outside the School Premises)

I/We allow my/our son/daughter, _________________________________________


from the Grade _____ - ______________ of the Pampanga High School – Senior High
School Department (PHS-SHS Department), to participate in the study titled
_____________________________________________________________________________.
I am fully aware that he/she (my/our son/daughter) had the option to choose a study
which can be conducted inside the premises of the school but he/she opted to conduct
one which can only be accomplished outside the school premises. I/We am/are well-
informed of the responsibilities and the possible risks of the said endeavor.

By signing this form, I/we am/are allowing my/our son/daughter to pursue


his/her chosen study and comply with all its requirements with the conditions that (1)
for every research-related activity that he/she will conduct outside the school premises,
my/our consent/permission shall be secured by the school and (2) a teacher-chaperone
or a parent/guardian-chaperone shall accompany him/her in the conduct of the said
activity/activities.

_________________________________________________
Signature over Printed Name of the Student-Researcher
Date signed: ___________________________________

_______________________________________________
Signature over Printed Name of the Parent/Guardian
Date signed: ___________________________________

1
(A) Print in three (3) copies: 1 for the parents/guardians, 1 for the research teacher and 1 for the research
coordinator; (B) Attach a photocopy of the valid ID of the parent/guardian; and (C) This form must be
accomplished as soon as the proposed research of the students, which is to be conducted outside the school
premises, has been approved by the research teacher and/or the panel members, if any.

You might also like