DNCR – F- ORD- 033/R0/01112019

Annex B

PARENTAL CONSENT FORM FOR TEST TAKERS

To whom it may concern,

This is to give consent to my child ____________________________________________

Name of Learner

enrolled in SAN AGUSTIN ELEMENTARY SCHOOL, Division of PARANAQUE CITY for the
Name of School

School Year 2020 – 2021, to take the LAMP Year End Exit Assessment this July 5-9, 2021.

Please put a check on the box that corresponds to your answer.

Grade level

Grade 1
Grade 4
Grade 6

Access to Assessment
Online

_______________________________________
Signature Over Printed Name
Date : June 24, 2021

I am not allowing my child, ____________________________________ , enrolled

in SAN AGUSTIN ELEMENTARY SCHOOL, Division of PARANAQUE CITY to participate in the

LAMP Year End Exit Assessment this July 5-9, 2021 due to

_____________________________________________________________________________________

_____________________________________________________________________________________

_______________________________________
Signature Over Printed Name
Date : June 24, 2021