Republic of the Philippines

Department of Education
REGION IVA-CALABARZON
SCHOOLS DIVISION OF LIPA CITY
LIPA CITY SCIENCE INTEGRATED NATIONAL HIGH SCHOOL
LIPA CITY, BATANGAS

AUTHORITY AND PARENTAL CONSENT FORM

I, ______________________________, permit my son/daughter, ________________________ of

(Name of Parent / Guardian) (Name of Student)
____________________ to attend the Week-long training for 2024 District Meet on the following
(Grade Level and Section) dates: November 28- December 1(3-5 pm), December 4-8 (3-5 pm),
December 11-15 (3-5 pm) and January 1-5 (7am-5 pm).

Following the pronouncements above I hereby declare the following:

 I and my child are fully and personally responsible for our own safety and actions while and
during attending the training.
 I and my child are fully aware of the actions, and causes of action whatsoever, directly or
indirectly arising out of or related to any accident or injury, that may be sustained by child
while participating to the Training.
 I will personally fetch my child at 5:00 PM on the aforementioned dates at the respective
training venue.
 I hereby allow my child to commute in case that I, his/her parent/guardian will not be available
to fetch him/her.

By signing below, I acknowledge that I have read AUTHORITY AND PARENTAL CONSENT
FORM and understand its contents; and fully competent to give my consent; That I and my child
have been sufficiently informed of the risks involved and give my voluntary consent in signing it as
my own free act and deed.

______________________________________
Student Signature over Printed Name

____________________________________ ___________________________
Parent / Guardian Signature over Printed Name Parent Contact Number

LIPA CITY SCIENCE INTEGRATED NATIONAL HIGH SCHOOL

#611, B. Morada St., Brgy. Uno, Lipa City, Batangas 4217
E-Mail Addresslipacityscienceinhs@gmail.com | 301492@deped.gov.ph
Contact Number: (043) 405-3663