REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF EDUCATION
DISASTER RISK REDUCTION AND MANAGEMENT SERVICE
Rm206MABINI BLDG., DEPED COMPLEX, MERALCO AVENUE, PASIG CITY
Tel. Nos. +632-635-3764; +632-637-4933
Mobile Nos. +63908-2630382; +63915-5153138
Email address: drrmo@deped.gov.ph

CONSENT FORM

In relation to the Online Learning Activities for Elementary and Secondary Learners
of the Department of Education through Disaster Risk Reduction and Management
Service (DRRMS) on May 19- August 20, 2020, the undersigned:

• confirms that his/her daughter/son has understood what this activity is about
and is aware of its outcomes;
• shall be given his/her daughter/son the opportunity to ask questions and have
them answered satisfactorily;
• shall be allowed his/her daughter/son to maintain anonymity and
confidentiality especially in the personal information that his/her
daughter/son will share; and
• understands that his/her daughter/son participation is voluntary and is free
to withdraw any information given at any time.
I am hereby allowing my daughter/son to be part of this activity and relay his/her
personal stories and recovery efforts on COVID-19 outbreak that shall be published in
social media platforms which will be streamed and may be uploaded by the DRRMS for
public consumption.

Signed:

____________________________
Learner’s Name

____________________________
Parent’s Name

____________________________
Parent’s Signature

____________________________
Date Signed