Republic of the Philippines

Department of Education
REGION III-CENTRAL LUZON
SCHOOLS DIVISION OF ZAMBALES
SAN RAFAEL HIGH SCHOOL
SAN MARCELINO, ZAMBALES

PARENT/GUARDIAN CONSENT FORM

The SAN RAFAEL HIGH SCHOOL, San Rafael San Marcelino Zambales, has requested this
waiver in connection with its FIELD/WORK IMMERSSION Program offered this 2nd Semester of
S.Y. 2022-2023 and which is accepted and confirmed. The student-trainee,

Complete Name, Strand and Year

___________________________________________________ TVL - GRADE 12

Together with his/her parents or judicially appointed guardian acknowledgement that the permission
granted to him is made subject to the condition, which he/she hereby accepts and agrees to, that the
school will not assume any responsibility whatsoever for any injury or accident which may happen to
him within or outside the premises of the project area during the period of said program. It is
understood that there is no employer-employee relationship between the school and the student-
participant.

This waiver will be in effect for the duration of April to May, 2023. (The duration of this program)

Done this 27th day of March 2023, in San Marcelino, Zambales.

______________________ _______________________________
Signature of Student Signature over Printed Name of Parent or
Judicially Appointed Guardian

PARENT/GUARDIAN CONSENT FORM

 Republic of the Philippines
Department of Education
REGION III-CENTRAL LUZON
SCHOOLS DIVISION OF ZAMBALES
SAN RAFAEL HIGH SCHOOL
SAN MARCELINO, ZAMBALES

The SAN RAFAEL HIGH SCHOOL, San Rafael San Marcelino Zambales, has requested this
waiver in connection with its FIELD/WORK IMMERSSION Program offered this 2nd Semester of
S.Y. 2022-2023 and which is accepted and confirmed. The student-trainee,

Complete Name, Strand and Year

___________________________________________________ HUMSS - GRADE 12

Together with his/her parents or judicially appointed guardian acknowledgement that the permission
granted to him is made subject to the condition, which he/she hereby accepts and agrees to, that the
school will not assume any responsibility whatsoever for any injury or accident which may happen to
him within or outside the premises of the project area during the period of said program. It is
understood that there is no employer-employee relationship between the school and the student-
participant.

This waiver will be in effect for the duration of April to May, 2023. (The duration of this program)

Done this 27th day of March 2023, in San Marcelino, Zambales.

______________________ _______________________________
Signature of Student Signature over Printed Name of Parent or
Judicially Appointed Guardian