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Republic of the Philippines

Department of Education
Region IV – A CALABARZON
Division of Rizal
SAMPALOC NATIONAL HIGH SCHOOL
(Grade 7 – 12)
Tanay, Rizal

PARENTS’/GUARDIAN’S CERTIFICATION OF WAIVER/PERMISSION

This is to certify that I am allowing my son/daughter,


_______________________________ to go on Immersion/Practicum for a minimum of ten
(10) days, or 80 hours, starting on______ day of _______________ 2017 until_____ day of
_________________, 2017 at __________________________in partial fulfillment of the
requirements for General Academic Strand (GAS) of Senior High School K-to-12 Curriculum.

It is understood that he/she will abide the rules and regulations that may be
imposed by the Supervisor / Staff-in-Charge for his/her welfare and safety.

I fully agree to waive any responsibility on the part of DepEd-SAMPALOC


NATIONAL HIGH SCHOOL, MUNCIPALITY OF TANAY, and or the representative/s, in case of
any untoward incident that may happen to my son/daughter during the duration of the
immersion.

_______________________ _______________________
Parent/guardian’s Signature over Printed Name Student’s Signature over Printed Name

_______________________
Parent/guardian’s Signature over Printed Name

_________________________
Address
________________________
(Tel./ Cell No.)
_______________________
Date
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
SAMPALOC NATIONAL HIGH SCHOOL
(Grade 7 – 12)
Tanay, Rizal

PARENTS’/GUARDIAN’S CERTIFICATION OF WAIVER/PERMISSION

This is to certify that I am allowing my son/daughter,


_______________________________ to go on Immersion/Practicum for a minimum of ten
(10) days, or 80 hours, starting on______ day of _______________ 2017 until_____ day of
_________________, 2017 at __________________________in partial fulfillment of the
requirements for Tech. Voc. – Electrical Installation Maintenance (EIM) of Senior High
School K-to-12 Curriculum.

It is understood that he/she will abide the rules and regulations that may be
imposed by the Supervisor / Staff-in-Charge for his/her welfare and safety.

I fully agree to waive any responsibility on the part of DepEd-SAMPALOC


NATIONAL HIGH SCHOOL, MUNCIPALITY OF TANAY, and or the representative/s, in case of
any untoward incident that may happen to my son/daughter during the duration of the
immersion.

_______________________ _______________________
Parent/guardian’s Signature over Printed Name Student’s Signature over Printed Name

_______________________
Parent/guardian’s Signature over Printed Name

_________________________
Address
________________________
(Tel./ Cell No.)
_______________________
Date
Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
SAMPALOC NATIONAL HIGH SCHOOL
(Grade 7 – 12)
Tanay, Rizal

PARENTS’/GUARDIAN’S CERTIFICATION OF WAIVER/PERMISSION

This is to certify that I am allowing my son/daughter,


_______________________________ to go on Immersion/Practicum for a minimum of ten
(10) days, or 80 hours, starting on______ day of _______________ 2017 until_____ day of
_________________, 2017 at __________________________in partial fulfillment of the
requirements for Tech. Voc. - Tourism of Senior High School K-to-12 Curriculum.

It is understood that he/she will abide the rules and regulations that may be
imposed by the Supervisor / Staff-in-Charge for his/her welfare and safety.

I fully agree to waive any responsibility on the part of DepEd-SAMPALOC


NATIONAL HIGH SCHOOL, MUNCIPALITY OF TANAY, and or the representative/s, in case of
any untoward incident that may happen to my son/daughter during the duration of the
immersion.

_______________________ _______________________
Parent/guardian’s Signature over Printed Name Student’s Signature over Printed Name

_______________________
Parent/guardian’s Signature over Printed Name

_________________________
Address
________________________
(Tel./ Cell No.)
_______________________
Date

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