PHILIPPINE SCIENCE HIGH SCHOOL

PILOT IMPLEMENTATION OF IN-PERSON CLASSES

The PHILIPPINE SCIENCE HIGH SCHOOL (PSHS)-ILOCOS REGION CAMPUS underwent a series of
consultations of risk and school safety assessment, and has received approval from the
appropriate Authorities to conduct in-person classes. This affirms PSHS System is compliant
with the minimum public health standards and protocols in creating a safe workplace and
classroom environment set by the government.
The in-person classes have the intention to ensure and maximize learning continuity experience
of scholars, ascertaining the readiness of the PSHS-IRC in having a whole-school in-person
classes in SY 2022-2023, and provide a safe environment by ensuring minimum health and
safety protocols are strictly complied with by all scholars, PSHS campus personnel, and visitors.
The in-person classes will be conducted from one to two grading periods based on minimal risk
from COVID-19.

DURATION
The In-Person classes will be held on January 23-February 11, 2022:

Subject/Activities Schedule/Venue Time

Arrival of January 23, 2022 8:00-5:00
Students/Accommodation at
the Residence Hall
Quarantine of Students at January 23-30, 2022
the Residence Hall (limited
movement)
Online classes January 24-28, 2022 8:00-12:00NN
Face to face classes (ASTB) January 31-February 11, 2022 8:00-12:00
every Monday, Tuesday and
Thursday for STEM Subjects

Online Classes (Residence

Hall/At Home/Boarding
House) every Wednesday
and Friday for Humanities
Subjects
Conduct of Research 2 1:00-4:00
Projects (laboratory works)
Wellness and Fitness 4:00-5:00
Activities
BENEFITS
The in-person classes will address difficulties of scholars in learning independently through
remote learning and lack of access to technology. Moreover, our scholars will gain better
experience and environment in learning, more engagement with information, interaction with
fellow scholars and in-depth guidance of homeroom or academic adviser, and access to
laboratories.

CONFIDENTIALITY
Any information that will be given during the activity will be kept strictly confidential, and
personal information will be treated in accordance with the Data Privacy Act of 2012. Be
assured that information about the parent and the scholar will not be shared or disclosed. The
scholar’s name or data will not be used during the evaluation of participants in the limited in-
person classes.

VOLUNTARY PARTICIPATION
Participation in this activity shall be VOLUNTARY. Parents or scholars may decline to participate
or to withdraw from participation at any time for any reason. Declining or withdrawal of
participation will not result in any penalty, or loss of benefits or reduction of any basic right to
which the scholar is entitled.
If parents or scholars decide to withdraw participation, kindly inform the CID Chief at
ducusinmb@irc.pshs.edu.ph, preferably in writing through the Academic Adviser of the
concerned scholar.

EXCLUSION (LIMITATIONS/INELIGIBILITY)
In accordance with the health and safety protocols, scholar/s without medical clearance from a
licensed medical doctor shall NOT be allowed to participate in the pilot implementation of in-
person learning modality.
Scholar/s who tested positive of COVID-19 or who have household members who tested
positive of COVID-19 shall follow the required IATF health and quarantine protocols and must
be cleared by a licensed medical doctor before a scholar may participate. The same applies to
scholar/s who tested positive during the actual implementation of in-person classes.
Parents/guardians shall sign a health declaration form prior the implementation of in-person
classes confirming that the scholar/s and/or any member of their household is not considered
as a close contact, suspect, probable, or confirmed COVID-19 case in the past fourteen (14)
days, and does not experience any symptoms related to COVID-19 such as, but not limited to,
fever or chills, cough, shortness of breath or difficulty of breathing, fatigue, muscle or body
aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea,
vomiting, and diarrhea before being permitted to participate in the limited in-person classes.
 CONSENT AND WAIVER FORM

As the parent or legal guardian of ______________________ (referred to as “scholar”) of Grade

11-Section, I hereby acknowledge that I have been informed of the details of the conduct of
pilot implementation of in-person learning.
I understand that PSHS-Ilocos Region Campus shall implement the minimum public health
standards and protocols set by the government to minimize risk of the spread of COVID-19, but
it cannot guarantee that scholars will not become infected with COVID-19, given that COVID-19
is highly contagious.
I understand that the my child’s in-person attendance in school will include associating with
academic adviser, fellow scholars and selected PSHS faculty and staff, and other persons inside
and outside of the PSHS-Ilocos Region that may put scholar at risk of COVID-19 transmission,
notwithstanding the precautions undertaken by the PSHS-Ilocos Region Campus.
I acknowledge that my child’s participation in this in-person class is COMPLETELY VOLUNTARY.
While there remains the risk of possible COVID19 transmission to my child, and to the members
of our household, I freely assume the said risk and I permit my child to attend in-person classes.
I am aware that symptoms of COVID-19 include, but are not limited to, fever or chills, cough,
shortness of breath or difficulty of breathing, fatigue, muscle or body aches, headache, new
loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea.
I confirm that my child currently has none of those symptoms, and is in good health with
corresponding medical clearance issued by a licensed medical doctor. I will not allow my child
to physically go to PSHS-Ilocos Region Campus to attend in-person classes if my child or any
member of my household develops any of the said symptoms or any other flu-like symptoms of
illness that may or may not be related to COVID-19. I will also inform the PSHS-Ilocos Region
Campus and not allow my child to attend in-person classes if my child or any of my household
members tests positive for COVID-19. My child and I, with my household members, will follow
the required latest IATF health and quarantine protocols and procedures adopted by PSHS-
Ilocos Region Campus and our community.
To the extent allowed by law and rules, I hereby agree to waive, release, and discharge all other
claims, causes of action, damages, and rights against the PSHS-Ilocos Region Campus and its
personnel relative to the conduct of the in-person classes.
With full understanding, I – on behalf of myself, my household members, and my child– hereby
freely and voluntarily give my consent to scholar’s participation in the implementation of in-
person learning from January 23-February 11, 2022. I also attest that I had sought the views of
the child and he/she has expressed willingness to participate in the in-person classes.
CONTACT DETAILS FOR QUESTIONS OR PROBLEMS
For any concern or clarification, you may contact PSHS-Ilocos Region Campus through the
following Grade 11 Academic Advisers:
Jerile Mae M. Casimiro (Grade 11-Mendel)-casimirojm@irc.pshs.edu.ph
Jerick A. Viz (Grade 11-Dalton)-vizja@irc.pshs.edu.ph
Mark L. Lucas (Grade 11-Newton)-lucasml@irc.pshs.edu.ph

Signature of Parent / Guardian over Printed Address:

Name:

Contact Details:
Signature of Scholar over Printed Name: Date: