TECHNOLOGICAL UNIVERSITY OF THE PHILIPPINES

College of Industrial Education

Student Teaching Department

PARENTAL CONSENT AND WAIVER FORM

This is to certify that I am allowing my son/daughter __[STUDENT’S NAME]_ to be attend the

limited face to face class for the in campus teaching at the College of Industrial Education,
Technological University of the Philippines-Manila.
The said examination is a requirement intended for their internship for the In-Campus Practice
Teaching in line with CHED’s Revised Guidelines on the deployment of the Student Teachers, as they
will be deployed to different schools under the Division of City Schools in Manila.
I understand that [NAME OF SCHOOL] shall follow the government's minimal public health
regulations to reduce the risk of COVID-19 transmission, but it cannot guarantee that my child will not
contract COVID-19 since COVID-19 is highly contagious.
I understand that my child's in-person presence at university for the said examination will
include interactions with teachers, fellow students, school officials, and other people within and outside
the school who may expose my child to COVID-19 transmission, despite the university’s
implementation of strict health measures.
I am aware that symptoms of COVID-19 include, but are not limited to, fever or chills, cough,
shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste
or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea.
I confirm that my child currently has none of those symptoms and is in good health. I will not
allow my child to physically go to the university to undergo the examination that will be within the
abovementioned schedule. I will also inform the school and not allow my child to attend face-to-face
classes if my children or any of my household members tests positive for COVID-19. My child and I,
with my household members, will follow the required health and safety protocols and procedures
adopted by the school and our community.
I, [PARENT/GUARDIAN’S NAME] do hereby consent the presence of my child, [STUDENT’S
NAME] to attend and participate on the said examination.

______________________________ ______________________________
Student’s Name and Signature Parent’s Name and Signature

______________________________ ______________________________
Date Date

Some parts of this letter were adapted from DepEd Parental Consent and Waiver Form on the Pilot Implementation of Face-
to-Face Classes.