Republic of the Philippines

Department of Education
NATIONAL CAPITAL REGION
SCHOOLS DIVISION OFFICE OF QUEZON CITY
SAUYO HIGH SCHOOL

DATE: _________________

P A R E N TA L CONSENT

I hereby willingly and voluntarily give consent to the participation of my son/daughter,

_________________________________________________________ (FULL NAME OF STUDENT)
of ___________________________________________________ (GRADE LEVEL AND SECTION)
in the ________________________________________________________ (NAME OF ACTIVITY)
that will be held at __________________________________________ (VENUE OF ACTIVITY)
on _________________________________________________ (DATE).

I have considered the benefits that my son/daughter will derive from his/her
participation in this activity, provided that due care and precautions are taken to ensure
my son/daughter's comfort and safety, and Sauyo High School personnel are not held
liable for any untoward incident that occurs outside of their control.

______________________________________________________________
SIGNATURE OF PARENT/GUARDIAN OVER PRINTED NAME

Contact number: ____________________________

Prepared by:

CATHLEA B. ABEJUELA
MAPEH Club Adviser

Noted by:

MARY GRACE G. PUNZALAN

Head Teacher IV, MAPEH

Approved by:

GILORE E. OFRANCIA, MTM, PhD

Principal IV

… Pantabangan Street, NIA Village, Sauyo, Quezon City

(02) 8283-40-15
hs.sauyo@depedqc.ph