Republic of the Philippines

Department of Education
Region VIII- EASTERN VISAYAS
SCHOOLS DIVISION OF LEYE
BALUD ELEMENTARY SCHOOL
BALUD, CAPOOCAN, LEYTE

Office of the Principal

WAIVER OF THE PARENTS/GUARDIANS FOR THE PILOT

IMPLEMENTATION OF LIMITED FACE- TO – FACE CLASSES

Ako hi __________________________________________ ginikanan/ nag- atiman kan

____________________________ diri natugot nga paapilon ko an bata ha Pilot Implementation
of Limited Face- to – Face Classes para ha mga pinili nga Grade __ Section Gold han BALUD
ELEMENTARY SCHOOL , tungod han masunod nga mga rason ( Alayon pag check (/) an imo
rason.)
______ An distansiya han pagbiyahi tikang ha balay ngada eskwelahan.
______Waray pa Vaccine kontra Covid-19 .
_____Nahadlok ako nga Matapnan han Covid-19 akon anak.
_____May ada hiya Health Problem.
_____ Diri pa Safe ha gawas an akon anak han Covid -19.

_________________________________
Ngaran ngan Pirma han Ginikanan/Petsa

Address: Balud, Capoocan,Leyte

Contact Number: 0917- 156- 1784
E-mail: 121236@deped.gov.ph
 Republic of the Philippines
Department of Education
Region VIII- EASTERN VISAYAS
SCHOOLS DIVISION OF LEYE
BALUD ELEMENTARY SCHOOL
BALUD, CAPOOCAN, LEYTE

VOLUNTARY CONSENT OF THE PARENTS/GUARDIANS

Ako hi __________________________________________ ginikanan/ nag- atiman kan

________________________ naghatag han akon pag-tugot nga maapil an bata ha Pilot
Implementation of Limited Face- to – Face Classes para ha mga pinili nga Grade ______Section
___________ han Balud Elementary School.

__________________________________
Ngaran ngan Pirma han Ginikanan/ Petsa

Address: Balud, Capoocan,Leyte

Contact Number: 0917- 156- 1784
E-mail: 121236@deped.gov.ph
 Republic of the Philippines
Department of Education
Region VIII- EASTERN VISAYAS
SCHOOLS DIVISION OF LEYE
BALUD ELEMENTARY SCHOOL
BALUD, CAPOOCAN, LEYTE

Address: Balud, Capoocan,Leyte

Contact Number: 0917- 156- 1784
E-mail: 121236@deped.gov.ph