Revised as of September 26, 2019

Republic of the Philippines

DEPARTMENT OF EDUCATION
2
(REGION)
DIVISION OF NUEVA VIZCAYA
(DIVISION)
DUPAX DEL NORTE NATIONAL HIGH SCHOOL
(School)
Malasin, Dupax del Norte, Nueva Vizcaya
(School Address)

April 19, 2022

Date

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of

my/our daughter MARY LHYSSBETH PRAISE DILAN MARCIANO in
CAVRAA 2022 which will be held at Cagayan Province on April 25-28, 2022

I/We have considered the benefits that my son or daughter will derive
from his/her participation in this activity provided that due care, diligence and
necessary precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to

collect, process, retain, and dispose of personal information of the above-
mentioned athlete in accordance with the Data Privacy Act of 2012.

LEZLEY DILAN MARCIANO

Signature of Father Over Printed Name Signature of Mother Over Printed Name

________________________________
Signature of Guardian Over Printed Name

________________________________
(Relationship with the athlete)

Verified:

SONNY L. AGUILAR, JR. MYLENE O. CASTRO, PhD

Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)

Remarks: