Republic of the Philippines

Department of Education
REGION III-CENTRAL LUZON
SCHOOLS DIVISION OF ZAMBALES
STA. FE NATIONAL HIGH SCHOOL
SAN MARCELINO, ZAMBALES

PARENT/GUARDIAN CONSENT FORM

The STA. FE NATIONAL HIGH SCHOOL, Sta. Fe 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

___________________________________________________ GAS - 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 June, 2023. (The duration of this program)

Done this 21th day of March 2023, in the San Marcelino, Zambales.

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

Sta. Fe National High School

SCHOOL Address: San Marcelino, Zambales
LOGO Email Add: 3010352@deped.gov.ph
FB Account: Sta Fe National High School