Republic of the Philippines

Department of Education
National Capital Region
Schools Division Office of Caloocan City
DEPARO ELEMENTARY SCHOOL
Kabatuhan Road, Deparo Caloocan CIty

PARENTS/GUARDIAN CONSENT FORM

Name of Learner:_______________________________________________________
Grade and Section: _____________________________________________________
Adviser:________________________________________________________________
Date of Birth: ____________________________ Age: __________________
Name of Parent/Guardian: ______________________________________________
Relationship to the Learner:_____________________________________________
Contact Number: _______________________________________________________
Title of the Activity: Journalism Orientation
Venue: Deparo Elementary School
Date: September 9, 2022 ( Friday)
Time: 9:00am - 11:30 am

As the parent/guardian of the above mentioned learner, I hereby acknowledge that I have been
informed of the details of the Journalism Orientation. Furthermore, I understand the risks associated with this
activity because of the Covid-19 Virus and agree that I will instruct him/her to follow and obey the rules and
regulations, safety and healthy protocols of the school.
Having understood all the aforementioned, I hereby consent to allow my child/children to participate
in this activity and I am solely responsible for providing transportation allowance, food/snacks or any expenses
of my child’s/children’s participation in the said activity.

Parent/Guardian Signature over Printed Name Date: _____________

Address: Kabatuhan Road, Deparo Caloocan City

Telephone No.: (02) 855 – 56 – 88
Email Address: deparo_es_deped@yahoo.com
Website: