PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my

son/daughter_________________________________ in the Two-Day Scholars’ Formation
Name of Scholar

Program under the Department of Science and Technology-Science Education Institute to be

held at ____________________________________ on _____________________________.

I have considered the benefits that my son/daughter will derive from his/her
participation in this activity with the understanding that due care and precaution will be
observed to ensure the comfort and safety of the participants.

_______________________ ______________________
Signature of Father Signature of Mother

_______________________ ______________________
Name of Father Name of Mother

_______________________ ______________________
Date Date

_________________________________
Signature of Guardian over Printed name

_________________________________
Relationship with the student

_________________
Date