CONSENT FORM

Name of Pupil/Student: JUAN C. DELA CRUZ

GRADE SIX/ELEMENTARY—para sa elem

Grade Level:
GRADE 10 /JUNIOR HIGH SCHOOL-para sa JHS

Name of
CRISOSTOMO S. DELA CRUZ
Parent/Guardian:

I hereby give my consent to RIZAL ELEMENTARY SCHOOL and the designated teachers of
my child/ward to:

1. Conduct online interaction through whatever social media platforms with my

child/ward for any distance learning activities;
2. To keep a record of online interaction with my child/ward, whenever
recording is made;
3. To take snapshots/images/videos which may include my child’s/ward’s image
for documentation and other lawful purposes;
4. To post in the official school social media page/web page/private social media
group: the image, name, and section of my child/ward as well as any
acknowledgement/awards that he/she is entitled;
5. Other similar processing of information of my child/ward for any activities
sanctioned

PIRMA DITO
July 2, 2021 CRISOSTOMO S. DELA CRUZ
Date Signed Signature Over Printed Name