Republic of the Philippines

Department of Education
REGION II – CAGAYAN VALLEY
SCHOOLS DIVISION OF CAGAYAN
LICERIO ANTIPORDA SR. NATIONAL HIGH SCHOOL- MAIN

Parent’s Consent Form

TO WHOM IT MAY CONCERN:

This is to permit my son/ daughter _____________________________________ of

Grade 12 TVL ICT to participate in the Home-Based Work Immersion as a
requirement for the completion of the Senior High School Program.

Since he/she will be under our care, we will not hold Licerio Antiporda Sr.
National High School- Main responsible for any incident that may happen beyond
our control during the said activity.

_____________________________________
Parent’s Signature over Printed Name

_____________________________________
Date

Noted by:

REYNALDO P. USIGAN
Principal II

Date: ________________