PARENTAL/GUARDIAN

CONSENT FORM

NAME OF CHILD (Pangalan ng Bata):

AGE (Edad): SEX (Kasarian):

NAME OF THE PARENT/GUARDIAN (Pangalan ng magulang/tagapag-alaga):
HOME ADDRESS (Tirahan):
CONTACT NUMBERS CELLULAR PHONE: EMAIL ADDRESS:
(Telepono/Landline):

I, ______________________________________ (name of parent) hereby certify that

______________________________________________________ (name of the child),

• is allowed to take part in the 2022 Virtual Division Scilympics;

• is allowed to speak or perform publicly as shown in any social media account only used for the
purpose of the activity is accompanied by an adult entrusted to do so:
______________________________________________ (name of the support staff/parent/guardian)

I, also GRANT permission to the organizers to publish pictures and videos of my child (mentioned
above) in promotional videos, press release, video presentation or any form of publicity. I understand
that if I happen to have objection towards any of the released graphic materials, it will be removed as
soon as possible.

SIGNATURE (Pirma): DATE (Petsa):