Department of Education

Region VIII
Schools Division of Ormoc City
District II
Ipil National High School
Ipil, Ormoc City

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter ______________________________ in the Learning Camp from (Dates of
Attendance) __________________________________________________ .

I have considered the benefits that my son/daughter will get 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. DepEd employees and personnel
may not be held responsible for any untoward incident that may happen beyond their
control.

______________________________ __________________________
Signature of Father Signature of Mother
Over Printed Name Over Printed Name

____________________________
Signature of Guardian
over Printed Name and Date

__________________________________
Relationship with the learner

Verified By:

Teacher : ________________________________ Date: ______________________

Note: If no Parent/s, submit Affidavit of Guardianship duly certified by the teacher. if parents are abroad a special power
of attorney (SPA) is tendered.

Reply Slip:

I will allow my son/daughter __________________________ to participate the NLC.

I will not allow my son/daughter _____________________ to participate the NLC.

Reason for not allowing: ___________________________________________________

Signature of Parent/Guardian: ________________________ Date: ______________________