Republic of the Philippines

Department of Education
REGION IVA-CALABARZON
SCHOOLS DIVISION OF LIPA CITY
LIPA CITY SCIENCE INTEGRATED NATIONAL HIGH SCHOOL
LIPA CITY, BATANGAS
Supreme Student Government

SSG and SPTA Outreach Program

December 10, 2022
1:00 – 3:00 PM
PARENTAL CONSENT

I, ___________________, allow my son / daughter ____________________

to
(Name of Parent/Guardian) (Name of Student)

attend the SSG and SPTA Outreach Program. I am allowing him/her to

fulfill the duties and responsibilities as a member of the Supreme Student

Government and to be involved in all its activities, programs, and projects.

_________________________________________
________________
Parent/Guardian’s Signature over printed name Date

LIPA CITY SCIENCE INTEGRATED NATIONAL HIGH SCHOOL

#611, B. Morada St., Brgy. Uno, Lipa City, Batangas 4217
E-Mail Address: lipacityscienceinhs@gmail.com | 301492@deped.gov.ph
Contact Number: 403-2786