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Republic of the Philippines

Department of Education
Region IV-A CALABARZON
CITY SCHOOLS DIVISION OFFICE OF ANTIPOLO
ANTIPOLO CITY NATIONAL SCIENCE AND TECHNOLOGY HIGH SCHOOL
OFFICE OF THE SUPREME STUDENT GOVERNMENT

Enclosure No. 5: Parental Consent Form


February 13, 2023

PARENTAL CONSENT FORM

I, ______________________ hereby authorize my child named ____________________ to stay

after class from 2:00 PM to 5:00 PM on Tuesday, February 14, 2023. This is in line with the

conduct of 2023 Valentine’s Day Celebration with the theme “To love or to be loved?”

spearheaded by ACNSTHS Supreme Student Government on ACNSTHS School Grounds.

Moreover, I hereby understand the nature of the said activity and its outcomes, as well as my

son’s/ daughter’s participation is purely voluntary.

Learner’s Grade and Section: ________________________________________

Mode of Transportation (service/ commute): ___________________________

Parent/ Guardian Signature: _________________________________________

Date Signed: ______________________________________________________

Received by (by SSG): ______________________________________________

AIM HIGH, DREAM HIGH, ANSCI


Facebook: facebook.com/AnSciSSG Email: anscissg.org@gmail.com
Twitter: twitter.com/anscissg Sitio Cabading, San Jose, Antipolo City

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