Republic of the Philippines

National Capital Region

Division of Pasig City
Rizal High School Supreme Student Government
Dr. Sixto Antonio Avenue, Caniogan, Pasig City
RHS STEM Alliance
Parents Consent Form
The Rizal High School - STEM Alliance Organization, aims to create an environment for
students where they have the freedom to show their skills and talents in various aspects not
only in Science, Technology, Engineering, and Mathematics.
With this, The RHS - STEM Alliance will be conducting a Hip-Hop Dance Competition during
STEM Week, among Grade 12 STEM students that aimed to showcase their skills in creating
choreography and talents in dancing.
This activity will be conducted on the Grounds of the MAE Building, Rizal High School on
December 14, 2022, from 2 PM onwards.

NOTE: A Photocopy of the Parent’s ID shall be attached to this consent form. A hard copy of
this form and the Photocopy of Parent’s ID must be collected a week before the program.
I, Rosel Pagsuyuin Parent/Guardian of Warren Pagsuyuin is allowing my child to participate in
the upcoming Grade 12 Hip-Hop Dance Competition for STEM Week. To be held at MAE
Grounds, Rizal High School on December 14, 2022, from 2 PM onwards.
Terms and Conditions:
I hereby agree to the terms and conditions that:
● The data submitted using this form will be solely used for the data transparency of the
student’s participation in the Grade 12 Dance Competition for STEM week. According to
R.A 10173, otherwise known as the Data Privacy Act, it states data is to be protected in
all forms of information, be it private, personal, or sensitive. There are covers for both
natural and juridical persons involved in the processing of personal information.

● This competition will serve as their Performance Task #1 on Health Optimizing Physical
Education 3 (HOPE 3). Participation and attendance of students at the said event are
recorded.

● Students are expected to report to the school for their scheduled date of practice for the
dance competition.

● Participants are expected to observe social distancing and follow health protocols
during, before, and during practices and during the program.

● "NO PARENTAL CONSENT FORM, NO PARENTS ID PHOTOCOPY, PARTICIPATION

WILL BE DISCARDED": Regardless of age, all participants will be given a PARENTAL
CONSENT FORM to enlighten their parents/legal guardians regarding the activity of the
student. Furthermore, the Parental consent form must be a PHYSICAL COPY with the
parent's printed name over their signature.

I agree with the Terms and Conditions stated above.

________Rosel Pagsuyuin_________ ____08/12/2022_______

PARENT SIGNATURE OVER PRINTED NAME DATE

attach a photocopy of the parent’s ID with this consent form

Address: Rizal High School, Dr. Sixto Antonio Avenue, Caniogan, Pasig
City
Contact No. 09927177747
Email: therizalhighssg@gmail.com
 Republic of the Philippines
National Capital Region
Division of Pasig City
Rizal High School Supreme Student Government
Dr. Sixto Antonio Avenue, Caniogan, Pasig City
RHS STEM Alliance

Prepared by:

Raia Rysel Gaspar

Muse, STEM Alliance

Noted by:

Stephanie Gabrielle Agonos Mario Butlig

President, STEM Alliance Teacher, HOPE 3

Address: Rizal High School, Dr. Sixto Antonio Avenue, Caniogan, Pasig
City
Contact No. 09927177747
Email: therizalhighssg@gmail.com