Republic of the Philippines

Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

PARENTAL CONSENT FORM FOR END-OF-SCHOOL-YEAR CLASSES

I, _____________________________________
GINA ELESTERIO hereby state that I am the
Name of Parent/Guardian

MOTHER
______________________________ ANDREW GUBAL ELESTERIO
of _________________________________ with
Relationship of the Learner Name of the Learner

LRN # _________________________
131273120363  who is presently in ___________________
GRADE- 9 do
Grade Level

hereby signify my consent for my child to be enroll in the end of school year class that

will start on July 24, 2022 and end on CARMEN

AugustNAT’L
12,AHS2022 at
Name of School and Address

__________________________.

__GINA ELESTERIO____________
Name of Signature of Parent/Guardian

JULY 21, 2022

_________________
Date

In case of refusal, please provide reason/s.

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

RISKS, CONSENT AND WAIVER FORM

ANDREW GUBAL ELESTERIO

As the parent or legal guardian of _______________________________________, I
hereby acknowledge that I have been informed of the details on the conduct of end-of-
school-year classes.

I understand that Carmen National Agricultural High School shall implement the
minimum public health standards set by the government to minimize risk of the spread
of COVID-19, but it cannot guarantee that my child will not become infected with
COVID-19, given that COVID-19 is highly contagious during the conduct of the activity.

I acknowledge that my child’s participation in this activity is completely voluntary. While

there remains the risk of possible COVID19 transmission to my child/ren, and to the
members of my household, I freely assume the said risk and I permit my child/ren to
attend school under this activity.

To the extent allowed by law and rules, I hereby agree to waive, release, and discharge
any and all claims, causes of action, damages, and rights against the school and its
personnel as well as officials and personnel of the Department of Education relative to
the conduct of the activity.

With full understanding, I – on behalf of myself, as legal guardian – hereby freely and
voluntarily give my consent to my learner participation in the activity from July 24, 2022
to August 12, 2022. I also attest that I had sought the views of my learner and he/she
has expressed willingness to participate in the activity.
Signature of Parent / Guardian over Printed Contact Details:
Name:
09105009348
GINA ELESTERIO

Name of theGUBAL
ANDREW LearnerELESTERIO Date:

JULY 21, 2022

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

In case of refusal, please provide reason/s:

PARENTAL CONSENT FORM FOR END-OF-SCHOOL-YEAR CLASSES

I, _____________________________________
GENALYN L. BAYOR hereby state that I am the
Name of Parent/Guardian

MOTHER
______________________________ JAY-R LAORDEN BAYOR
of _________________________________ with
Relationship of the Learner Name of the Learner

LRN # _________________________
132682100012  who is presently in ___________________
GRADE- 9 do
Grade Level

hereby signify my consent for my child to be enroll in the end of school year class that

will start on July 24, 2022 and end on CARMEN

AugustNAT’L
12,AHS2022 at
Name of School and Address

__________________________.

__GENALYN L. BAYOR____________
Name of Signature of Parent/Guardian

JULY 21, 2022

_________________
Date

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

In case of refusal, please provide reason/s.

RISKS, CONSENT AND WAIVER FORM

JAY-R LAORDEN BAYOR

As the parent or legal guardian of _______________________________________, I
hereby acknowledge that I have been informed of the details on the conduct of end-of-
school-year classes.

I understand that Carmen National Agricultural High School shall implement the
minimum public health standards set by the government to minimize risk of the spread
of COVID-19, but it cannot guarantee that my child will not become infected with
COVID-19, given that COVID-19 is highly contagious during the conduct of the activity.

I acknowledge that my child’s participation in this activity is completely voluntary. While

there remains the risk of possible COVID19 transmission to my child/ren, and to the
members of my household, I freely assume the said risk and I permit my child/ren to
attend school under this activity.

To the extent allowed by law and rules, I hereby agree to waive, release, and discharge
any and all claims, causes of action, damages, and rights against the school and its
personnel as well as officials and personnel of the Department of Education relative to
the conduct of the activity.

With full understanding, I – on behalf of myself, as legal guardian – hereby freely and
voluntarily give my consent to my learner participation in the activity from July 24, 2022
to August 12, 2022. I also attest that I had sought the views of my learner and he/she
has expressed willingness to participate in the activity.

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

Signature of Parent / Guardian over Printed Contact Details:

Name:
09122010518
GENALYN L. BAYOR

Name ofLAORDEN
JAY-R the LearnerBAYOR Date:

JULY 21, 2022

In case of refusal, please provide reason/s:

PARENTAL CONSENT FORM FOR END-OF-SCHOOL-YEAR CLASSES

I, _____________________________________
DAISY S. PLAZA hereby state that I am the
Name of Parent/Guardian

MOTHER
______________________________ JHON BRIX SANTIAGO PLAZA
of _________________________________ with
Relationship of the Learner Name of the Learner

LRN # _________________________
131273120363  who is presently in ___________________
GRADE- 9 do
Grade Level

not hereby signify my consent for my child to be enroll in the end of school year class

that will start on July 24, 2022 and end on August

CARMEN NAT’L12,
AHS2022 at
Name of School and Address

__________________________.

__ DAISY S. PLAZA ___________

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

Name of Signature of Parent/Guardian

JULY 21, 2022

_________________
Date

In case of refusal, please provide reason/s.

The mother is permitted for her son to take summer classes,

but the learner is not, as his son claims he has already
passed. Rather of intervening, the mother must simply accept
his son's choice.

RISKS, CONSENT AND WAIVER FORM

DAISY S. PLAZA
As the parent or legal guardian of _______________________________________, I
hereby acknowledge that I have been informed of the details on the conduct of end-of-
school-year classes.

I understand that Carmen National Agricultural High School shall implement the
minimum public health standards set by the government to minimize risk of the spread
of COVID-19, but it cannot guarantee that my child will not become infected with
COVID-19, given that COVID-19 is highly contagious during the conduct of the activity.

I acknowledge that my child’s participation in this activity is completely voluntary. While

there remains the risk of possible COVID19 transmission to my child/ren, and to the
members of my household, I freely assume the said risk and I permit my child/ren to
attend school under this activity.

To the extent allowed by law and rules, I hereby agree to waive, release, and discharge
any and all claims, causes of action, damages, and rights against the school and its
personnel as well as officials and personnel of the Department of Education relative to
the conduct of the activity.

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

With full understanding, I – on behalf of myself, as legal guardian – hereby freely and
voluntarily give my consent to my learner participation in the activity from July 24, 2022
to August 12, 2022. I also attest that I had sought the views of my learner and he/she
has expressed willingness to participate in the activity.
Signature of Parent / Guardian over Printed Contact Details:
Name:
0489424675
DAISY S. PLAZA

Name of the Learner Date:

JHON BRIX S. PLAZA JULY 21, 2022

In case of refusal, please provide reason/s:
The mother is permitted for her son to take summer classes, but the learner is not, as
his son claims he has already passed. Rather of intervening, the mother must simply
accept his son's choice.

PARENTAL CONSENT FORM FOR END-OF-SCHOOL-YEAR CLASSES

I, _____________________________________
ROWENA JANE AWAYAN hereby state that I am the
Name of Parent/Guardian

MOTHER
______________________________ EARL JHON MIANO AWAYAN
of _________________________________ with
Relationship of the Learner Name of the Learner

LRN # _________________________
132687120002 who is presently in ___________________
GRADE- 9 do
Grade Level

not hereby signify my consent for my child to be enroll in the end of school year class

CARMEN NAT’L AHS

Name of School and Address

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

that will start on July 24, 2022 and end on August 12, 2022 at

__________________________.

__ROWENA JANE AWAYAN_______

Name of Signature of Parent/Guardian

JULY 21, 2022

_________________
Date

In case of refusal, please provide reason/s.

We are already residing at Adlay, Carrascal, Surigao del Sur. We cannot afford
already the fare of our chidren in attending the summer class at Carmen National
Agricultural High School.

RISKS, CONSENT AND WAIVER FORM

As the parent or legal guardian of _______________________________________, I

hereby acknowledge that I have been informed of the details on the conduct of end-of-
school-year classes.

I understand that Carmen National Agricultural High School shall implement the
minimum public health standards set by the government to minimize risk of the spread
of COVID-19, but it cannot guarantee that my child will not become infected with
COVID-19, given that COVID-19 is highly contagious during the conduct of the activity.

I acknowledge that my child’s participation in this activity is completely voluntary. While

there remains the risk of possible COVID19 transmission to my child/ren, and to the
members of my household, I freely assume the said risk and I permit my child/ren to
attend school under this activity.

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

To the extent allowed by law and rules, I hereby agree to waive, release, and discharge
any and all claims, causes of action, damages, and rights against the school and its
personnel as well as officials and personnel of the Department of Education relative to
the conduct of the activity.

With full understanding, I – on behalf of myself, as legal guardian – hereby freely and
voluntarily give my consent to my learner participation in the activity from July 24, 2022
to August 12, 2022. I also attest that I had sought the views of my learner and he/she
has expressed willingness to participate in the activity.
Signature of Parent / Guardian over Printed Contact Details:
Name:
ROWENA JANE AWAYAN

Name
EARLofJHON
the Learner
MIANO AWAYAN Date:

JULY 21, 2022

In case of refusal, please provide reason/s:
We are already residing at Adlay, Carrascal, Surigao del Sur. We cannot afford
already the fare of our chidren in attending the summer class at Carmen National
Agricultural High School.

PARENTAL CONSENT FORM FOR END-OF-SCHOOL-YEAR CLASSES

I, _____________________________________
RICKY T. CASIO hereby state that I am the
Name of Parent/Guardian

FATHER
______________________________ RICK FRANCES ALTAMORINO CASIO with
of _________________________________
Relationship of the Learner Name of the Learner

LRN # _________________________
132711110018 who is presently in ___________________
GRADE- 9 do
Grade Level

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080 CARMEN NAT’L AHS
carmennationalagriculturalhs@yahoo.com Name of School and Address
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

not hereby signify my consent for my child to be enroll in the end of school year class

that will start on July 24, 2022 and end on August 12, 2022 at

__________________________.

__RICKY T. CASIO____________
Name of Signature of Parent/Guardian

JULY 21, 2022

_________________
Date

In case of refusal, please provide reason/s.

We are already residing at Matho, Cortes, Surigao del Sur.

RISKS, CONSENT AND WAIVER FORM

As the parent or legal guardian of _______________________________________, I

hereby acknowledge that I have been informed of the details on the conduct of end-of-
school-year classes.

I understand that Carmen National Agricultural High School shall implement the
minimum public health standards set by the government to minimize risk of the spread
of COVID-19, but it cannot guarantee that my child will not become infected with
COVID-19, given that COVID-19 is highly contagious during the conduct of the activity.

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com
 Republic of the Philippines
Department of Education
CARAGA REGION
Schools Division of Surigao del Sur
Carmen National agricultural High School
Carmen, Surigao Del Sur

I acknowledge that my child’s participation in this activity is completely voluntary. While

there remains the risk of possible COVID19 transmission to my child/ren, and to the
members of my household, I freely assume the said risk and I permit my child/ren to
attend school under this activity.

To the extent allowed by law and rules, I hereby agree to waive, release, and discharge
any and all claims, causes of action, damages, and rights against the school and its
personnel as well as officials and personnel of the Department of Education relative to
the conduct of the activity.

With full understanding, I – on behalf of myself, as legal guardian – hereby freely and
voluntarily give my consent to my learner participation in the activity from July 24, 2022
to August 12, 2022. I also attest that I had sought the views of my learner and he/she
has expressed willingness to participate in the activity.
Signature of Parent / Guardian over Printed Contact Details:
Name:

Name of the Learner Date:

RICK FRANCES ALTAMORINO CASIO JULY 21, 2022

In case of refusal, please provide reason/s:

Sitio Mahambung, Poblacion, Carmen, Surigao del Sur

0912-702-2080
carmennationalagriculturalhs@yahoo.com