Republic of the Philippines

DEPARTMENT OF DEUCATION
Region VI – Western Visayas
DIVISION OF SAN CARLOS CITY
JULIO LEDESMA NATIONAL HIGH SCHOOL
San Carlos City, Negros Occidental

PARENTAL CONSENT
I/We hereby willingly and voluntarily give consent the participation of my/our son/daughter
to join in the Provincial Jamboree in Dalapayan Eco-park,
Caduhaan, Cadiz City, Negros Occidental. This October 23-30, 2019.

I have considered the benefits that my son will derive from his participation in this activity
provided that due care and precautions will be observed to ensure the comfort and safety of my
son and that DepEd employees and personnel may not be held responsible for any untoward
incident that may happen beyond their control.

Signature of Parents / Guardian over Printed Name / Contact No.

What to Prepare:

1. Complete Uniform
2. Tenet
3. Water Bottle (with leash)
4. Jacket
5. Rain Boots (Black)
6. Raincoat (White Transparent)
7. Flashlight
8. Ballpen and Notebook
9. Complete personal eating utensils with net bag
10. Proper haircut (boys)
11. Rice 2 kg
12. Sardines 2
13. Noodles 1
14. Eggs 3
15. Meat loaf
16. Corned Beef 1
17. Food 20 x 21 meals = 420 pesos
18. 500 pesos registration
19. 50 pesos camp improvement (bamboo and etc.)
20. 190 pesos for fare / fuel of VAMOS BUS
21. Parent’s consent and medical Certificate
22. Good Attitude
 Republic of the Philippines
DEPARTMENT OF DEUCATION
Region VI – Western Visayas
DIVISION OF SAN CARLOS CITY
JULIO LEDESMA NATIONAL HIGH SCHOOL
San Carlos City, Negros Occidental

MEDICAL CERTIFICATE

(Date)

This is to certify that I have personally examined

age sex born on , and have found

that he/she is physically fit, during the time of examination, to join on Provincial Jamboree

in Dalapayan Eco-Park, Caduhaan, Cadiz City, Negros Occidental. This October 23-30,

2019.

Physical Examination:

Date Examined:
Height: Weight: Blood Pressure:
Pulse, Resting: Respiratory Rate:
Other Remarks:

Physician / Medical Officer

(Signature over Printed Name)

License No.:
PTR:
Date: