Republic of the Philippines Republic of the Philippines

Department of Education Department of Education

Region – V Region – V
School Division Office of Camarines Norte School Division Office of Camarines Norte
San Vicente-San Lorenzo Ruiz District San Vicente-San Lorenzo Ruiz District
V. RICFRENTE ELEMENTARY SCHOOL V. RICAFRENTE ELEMENTARY SCHOOL

Date:__________________ Date:__________________

NATIONAL LEARNING CAMP PARENTAL CONSENT NATIONAL LEARNING CAMP PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of I/We hereby willingly and voluntarily give consent to the participation of
my son/daughter, ________________________________________ in the my son/daughter, ________________________________________ in the
(Name of the Learner)
National Reading Camp. National Reading Camp.

I have considered the benefits that my son or daughter will derive from
his/her participation in this activity provided that due care and precaution will
be observed to ensure the comfort and safety of my son/daughter and that
DepED employees and personnel may not be held responsible for any untoward
incident that may happen beyond their control.
I have considered the benefits that my son or daughter will derive from
his/her participation in this activity provided that due care and precaution will
be observed to ensure the comfort and safety of my son/daughter and that
DepED employees and personnel may not be held responsible for any untoward
incident that may happen beyond their control.

________________________________ _______________________________ ________________________________ _______________________________

Signature of Father over Printed Name Signature of Mother over Printed Signature of Father over Printed Name Signature of Mother over Printed
and Date Name and Date and Date Name and Date

_________________________________ _________________________________
Signature of Guardian over Printed Name and Date Signature of Guardian over Printed Name and Date

Verified By: Verified By:

___________________________________ ____________________________ ___________________________________ ____________________________

Teacher Date Teacher Date