Parental Consent Form

Name of Student Organization: __________________________________________________________

Name of Activity: ______________________________________________________________________

Nature of Activity: Co-Curricular Extra-Curricular

Face to Face Activity: Online Activity:

Venue: __________________________________

Inclusive Dates: ______________________________________________________________________

I allow my son/daughter to attend the activity.

I trust that the organizers of this activity will take due diligence to ensure the safety of my son/daughter
as a participant.

I do not allow my son/daughter to attend the activity.

Name of Student: Raphael O. De Vera_________________________

Name of Parent/Guardian: RInna O. De Vera_______________________

Phone/Cell phone number: 09081614854_____________________________

Address: 0199 Taal Malolos Bulacan, Purok #1

Signature: ___________________ ____________________ ___________________

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