Republic of the Philippines

Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF QUEZON PROVINCE
GUMACA NATIONAL HIGH SCHOOL
GUMACA, QUEZON

PARENTAL CONSENT FORM FOR REMEDIAL CLASS

Date: _______________________

I, _________________________________________________ hereby state that I am _____________________

(Name of Parent/Guardian) (Relationship to the learner)

of _____________________________________________ with LRN # ______________________ who is presently in _______________

(Name of the Learner) (Grade Level)

do hereby signify my consent of my child to be enroll in remedial class for School Year 2021-2022 at Gumaca National High School,
Brgy. Mabini, Gumaca, Quezon.

______________________________________
(Name and Signature of Parent/Guardian)

_____________________________
(Date)

Gumaca National High School

Brgy. Mabini, Gumaca, Quezon 4307
Contact No. (042) 317-3365, (042) 317-3417
Email Address: depedgumacanhs@gmail.com