Revised as of September 26, 2019

Republic of the Philippines

Province of Quezon
Municipality of Candelaria
Barangay Masalukot I

_____________________
Date

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of

my/our son/daughter _____________________________ in
ST
_______________ in 1 Mayor George “Ogie” D. Suayan Inter-Barangay
Sports League 2023.

I/We have considered the benefits that my son or daughter will derive
from his/her participation in this activity provided that due care, diligence and
necessary precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of 1 ST Mayor George “Ogie” D.

Suayan Inter-Barangay Sports League 2023 to collect, process, retain, and
dispose of personal information of the above-mentioned athlete in accordance
with the Data Privacy Act of 2012.

Signature of Father Over Printed Name Signature of Mother Over Printed Name

Verified:

CYRILL MAE B. OCTOMAN

COACH SK CHAIRPERSON
(Signature Over Printed Name) (Signature Over Printed Name)

Remarks:

Note:
Submit the necessary documents, i.e. Affidavit/Sworn Statement of Actual Care and Custody
duly verified by the adviser and school head, in cases signature of parents are unavailable.