DEPARTMENT OF EDUCATION

Division of Bulacan
Norzagaray Academy,
Inc.
Norzagaray, Bulacan.

PARENTAL/ GUARDIAN CONSENT

Date:April 12, 2022

TO WHOM IT MAY CONCERN:

This is to certify that I allow my son/ daughter Franchesca Angeal A. Cruz of 7-Carnation to participate in face-to- face
Graduation and Recognition Rites (School Year 2021-2022) on April 29, 2022 and do hereby pledge that:

1. I will obey and abide the rules and regulations promulgated, enforced by the school for the protection and
safety ofall;

2. I hereby waive and renounce my rights to all damages, hospitalization, and the like. I will not hold the
school, staff and the teacher concerned responsible for any misfortune, injury, or accident be slight or serious,
that may happen in connection with theactivities.

ThecontentofthiswaiverwasreadandexplainedtomebeforeIaffixmynameandsignaturethis12 th
dayof April ,2022 freely and voluntarily.

Thank you verymuch!

Yours truly,

Parent/ Guardian

(Signature over printed name)