Republic of the Philippines

Department of Education
NATIONAL CAPITAL REGION
DIVISION OF PASIG CITY
SANTOLAN ELEMENTARY SCHOOL
EVANGELISTA AVENUE, SANTOLAN, PASIG CITY

ASHLEY ABBEY M. ANDERTON

Student’s Name ______________________________ 3 – WALING-WALING
Grade & Section ___________________

EUFEMIA VOLANTE
Name of Adviser: _____________________________

MEDIA CONSENT FORM

I fully understand the following:

✓ The name and photo of my child may be posted in Social Media as part of the
Documentation for the conduct of Online Class thus hereby giving my full parental consent.
✓ The photo and name of my child will be shown in the FB Post of the Teacher/Adviser.
✓ That my child’s name and photo will be solely used for posting of school activities held
for the whole school year of 2021-2022 under the supervision of the Teacher/Adviser

Signed:

JENNIFER M. ORDILLAS
________________________________________
Signature Over Printed Name of Parent/Guardian

Name of School: Santolan Elementary School

Address: Evangelista Avenue, Santolan, Pasig City
Telephone Nos: 8646-1020, 7955-5115
E-mail Address: santolanelementary@gmail.com