Republic of the Philippines

DEPARTMENT OF EDUCATION
Region I
SCHOOLS DIVISION OFFICE URDANETA CITY
Urdaneta City, Pangasinan

TERMS OF REFERENCE

I,______________________________, of __________________________________,
Name of Parent/Guardian Name of Child

_____________________________________________________
School

hereby state the following:

1. That I am willfully accepting the tablet to be utilized by my son/daughter in his/her

distance learning for the S.Y. 2021-2022 lend by the DepEd SDO Urdaneta City;

2. That in accepting the said equipment, as guardian to my child, we shall refrain from
using the equipment for any professional or private activity that would create a conflict
to DepEd educational purposes;

3. That I shall be accountable for the loss, destruction or any actions of my child in
utilizing the said equipment such as using it in gaming, social media activities, pawning
or selling it;

4. That I will not duplicate, make unauthorized use, or disclose the educational
materials installed thereto to any person other than the person designated to
coordinate with and receive any outputs from my child; and

5. That I am giving my consent to the SDO of Urdaneta City to monitor the utilization of
the equipment given to my child and to attend all the necessary monitoring activities
relative thereto;

Therefore, I hereby signify my full understanding and consent to the above declarations
this _______ day of ________________, _______.
Date Month Year

_____________________________
Signature

Date: _____________________

I,______________________________, of _____________________
Name of Declarant School

High School Drive San Vicente West,

Urdaneta City, Pangasinan
Telefax: 075 568 3054
Email: urdaneta.city@deped.gov.ph
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region I
SCHOOLS DIVISION OFFICE URDANETA CITY
Urdaneta City, Pangasinan

TERMS OF REFERENCE

High School Drive San Vicente West,

Urdaneta City, Pangasinan
Telefax: 075 568 3054
Email: urdaneta.city@deped.gov.ph