Republic of the Philippines

Department of Education
Region XI
Schools Division of _______
______ Schools District

List of Learners for Summer Enrichment

Name of Learner Grade Gender Learning Areas Class Adviser Kind of Proposed Time Time Remarks
Level below 79 Modality Schedule Frame
15 days
All Learning Face to July 22- August 15 days
Areas Face 12, 2022 15 days
Class 15 days
15 days
15 days

Submitted by:

School Principal I
 Republic of the Philippines
Department of Education
Region XI
Schools Division of _______
______ Schools District

PARENTAL CONSENT FORM FOR SUMMER CLASS

Date: _______________________________

I, ___________________________________________hereby state that I am the __________________________________

(Name of Parent/ Guardian) (Relationship to the learner)
of ___________________________________________ with LRN # _________________who is presently in Grade 1 , do hereby
(Name of the Learner)
signify my consent for my child to be enroll in summer class for School Year 2021-2022 at Elementary School, .

_______________________________
Name and signature of the Parent/ Guardian

I will allow my son/ daughter to participate in the summer class.

I will not allow my son/ daughter to participate in the summer class.