CENTER FOR COUNSELING AND STUDENT DEVELOPMENT

SCIENCE HIGH SCHOOL

General Luna Road, Baguio City Philippines 2600

Telefax No.: (074) 442-3071 Website: www.ubaguio.edu E-mail Address: ub@ubaguio.edu

PARENT CONSENT FORM

The University of Baguio Science High School upholds the holistic development of our scholars- including
academic, personal, social, and emotional growth of our students. Given the current situation brought about by
the COVID-19 pandemic, we are now accommodating students for Student Development Facilitation through
online and onsite modalities.

What is Student Development Facilitation (SDF)?

The SDF is the provision of relational and interactive process that aims to empower students to make informed
decisions, improve understanding of the self and others and coping with academic concerns through onsite
consultations and online platforms such as Google Meet and Messenger.

The confidentiality of the sessions is not changed even whether the session is conducted onsite or online. All
information obtained through SDF sessions shall be upheld with utmost care and confidentiality and to the best
interest of the student. However, information obtained through SDF may be subjected to disclosure only for the
following reasons:
● If the student is at risk of harming themselves or other people
● If the student is harmed by other people
● If it is required by the court of law

In some cases, limited amount of information may be given as a general feedback to the parents or concerned
teachers in order to help support the student. Information is shared with parents only in the best interest of the
student and with a view to ensure that any disclosures do not harm the on-going trust relationship between the
Student Development Facilitator and the student. As with any information transmitted over the internet, the
availability of the service and the security of the data cannot be guaranteed by the school.

PLEASE CHECK THE BOXES.

☐ Do you allow the assigned Student Development Facilitator to contact your child/ward for random
or purposive SDF (referred by teachers, academic O-SDF, etc.)?
☐ Do you allow your child/ward to be in a safe and secured place whenever he/she undergoes SDF,
where he/she cannot be heard by others?
☐ Do you allow the assigned Student Development Facilitators to include you as part of the
intervention program for your child/ward, as needed?

By affixing your signature in this form, you understand and agree to the statements you marked above.

_______________________________________ ____________________ ____________________

Name and Signature of Parent/ Legal Guardian E-mail Address Contact Number

________________________ ____________________ ____________________

Name of Child/ Ward Grade Level Date

You may contact the UB Science High School Center for Counseling and Student Development through:

A. Email Address: juyag_s@e.ubaguio.edu

B. Facebook Accounts: facebook.com/ccsdubshs
C. Instagram: @ubshsccsd
D. Phone Numbers: (074) 442 4915 local 296 or (074) 423 0278