Republic of the Philippines

DEPARTMENT OF EDUCATION
REGION VI-WESTERN VISAYAS
(Region)
DIVISION OF NEGROS OCCIDENTAL
(Division)
TUYOM ELEMENTARY SCHOOL
(School)
BRGY. TUYOM, CAUAYAN, NEG. OCC.
(School Address)

NOVEMBER 08, 2023

Date

P A R E N TA L C O N S E N T

I/We hereby willingly and voluntarily give consent the participation of my/our
son/daughter KEAN LANZ P. INLONG in the Cluster, District, Municipal, Division,
Regional Meet and Palarong Pambansa.

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 Signature of Mother

KELVIN M. INLONG LIEZEL P. INLONG

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :

________________ RAYMUNDO M. CAYA, JR.__________________

Teacher-Adviser/School Head/Registrar

Remarks:

FOR PALARONG PAMBANSA ONLY

 Republic of the Philippines
DEPARTMENT OF EDUCATION
REGION VI-WESTERN VISAYAS
(Region)
DIVISION OF NEGROS OCCIDENTAL
(Division)
TUYOM ELEMENTARY SCHOOL
(School)
BRGY. TUYOM, CAUAYAN, NEG. OCC.
(School Address)

NOVEMBER 08, 2023

Date

P A R E N TA L C O N S E N T

I/We hereby willingly and voluntarily give consent the participation of my/our
son/daughter RENZ JAN B. CANAGAN in the Cluster, District, Municipal, Division,
Regional Meet and Palarong Pambansa.

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 Signature of Mother

RUEL SR. B. CANAGAN SHERYL B. CANAGAN

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :

________________ RAYMUNDO M. CAYA, JR.__________________

Teacher-Adviser/School Head/Registrar

Remarks:

FOR PALARONG PAMBANSA ONLY

 Republic of the Philippines
DEPARTMENT OF EDUCATION
REGION VI-WESTERN VISAYAS
(Region)
DIVISION OF NEGROS OCCIDENTAL
(Division)
TUYOM ELEMENTARY SCHOOL
(School)
BRGY. TUYOM, CAUAYAN, NEG. OCC.
(School Address)

NOVEMBER 08, 2023

Date

P A R E N TA L C O N S E N T

I/We hereby willingly and voluntarily give consent the participation of my/our
son/daughter DENNIS JR. F. DEQUITO in the Cluster, District, Municipal, Division,
Regional Meet and Palarong Pambansa.

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 Signature of Mother

DENNIS SR. D. DEQUITO WIMMA F. DEQUITO

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :

________________ RAYMUNDO M. CAYA, JR.__________________

Teacher-Adviser/School Head/Registrar

Remarks:

FOR PALARONG PAMBANSA ONLY

 Republic of the Philippines
DEPARTMENT OF EDUCATION
REGION VI-WESTERN VISAYAS
(Region)
DIVISION OF NEGROS OCCIDENTAL
(Division)
TUYOM ELEMENTARY SCHOOL
(School)
BRGY. TUYOM, CAUAYAN, NEG. OCC.
(School Address)

NOVEMBER 08, 2023

Date

P A R E N TA L C O N S E N T

I/We hereby willingly and voluntarily give consent the participation of my/our
son/daughter DWANE T. LAPORE in the Cluster, District, Municipal, Division,
Regional Meet and Palarong Pambansa.

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 Signature of Mother

NILO JR. A. LAPORE LORENA T. TUMPAG

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :

________________ RAYMUNDO M. CAYA, JR.__________________

Teacher-Adviser/School Head/Registrar

Remarks:

FOR PALARONG PAMBANSA ONLY