Republic of the Philippines

Department of Education
____________________
Region
______________________________________
School
_______________________________________
School Address

_____________
Date:

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent the participation of

my/our son/daughter ___________________________________ in their
Work Immersion.

We believe that this Work Immersion program of our school will

sharpen my son’s/ daughter’s knowledge, skills during their Senior High
School.

_______________________ ________________________
Signature of Father Signature of Mother

_______________________ _________________________
Name of Father Name of Mother

__________________________________
Signature of Guardian over Printed name

__________________________________________
(Relationship with the student)

Verified by:

__________________________ _______________________
Teacher Adviser School Head/Registrar

Remarks:
 Republic of the Philippines
Department of Education
____________________
Region
______________________________________
School
_______________________________________
School Address

MEDICAL CIERTIFICATE

______________
Date

To Whom It May Concern

This is to certify that I have personally examined

Name ____________________________ age ____ sex ________ born on
_________________ and that found that he/she is physically fit, during the
time of examination, hence he/she is allowed to participate and have to attend
their Work Immersion.

Purpose: Work Immersion

Physical Examination

Date examined :_______________

Height: ________ Weight:________ Blood Pressure:________
Pulse Resting:_________________ Respiratory Rate:_______
Other Remarks: _____________________________________
_____________________________________
_____________________________________
_____________________________________

_____________________________
Physician Medical Officer
Signature over Printed Name

License No: ___________

PTM ___________
Date ___________
 Republic of the Philippines
Department of Education
____________________
Region
______________________________________
School
_______________________________________
School Address