PARENTAL CONSENT FORM FOR TEST-TAKERS

To whom it may concern,

This is to give consent to my child _________Arrian B. Mendoza_________

Name of Learner

enrolled as Grade __10___ in _Sta. Elena High School__, for the School Year
Name of School

2021-2022, to take the Exit Assessment on the schedule given by the school. I

understand that the result of the assessment shall not affect his/her grades and shall

solely be used for bridging purposes.

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

Access to Assessment

🗹 Online (at Home)

□ Bubble Sheet in (School)

___LOVELY MENDOZA___
Signature over Printed Name
of Parent or Guardian

Date: ___May 30, 2022____