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Republic of the Philippines

Department of Education
Region IX, Zamboanga Peninsula
SCHOOLS DIVISION OF ZAMBOANGA DEL NORTE
Capitol Drive, Estaka, Dipolog City, 7100
Tel No.: (065) 212-5843 e-mail address: zn.division@deped.gov.ph

PARENTAL CONSENT FOR SUMMER ENRICHMENT CLASS

I, hereby state that I am the


(Name of Parent/Guardian) (Relationship to the learner)

of with LRN # who is


(Name of the Learner)

presently in do hereby signify my consent for my child to be enroll in summer class for the
(Grade Level)

school year at Nebo Elementary School, Nebo, Sergio Osmeňa Sr., Zamboanga del Norte.

(Name and Signature of Parent/Guardian)

(Date)

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