Republic of the Philippines

Department of Education
Region VI- Western Visayas
Schools Division of Antique
District of San Jose

Parent’s Name: ________________________________________________________________________

Parent’s Address: ______________________________________________________________________
Date: _____________________________

Dear Mr. and Mrs. _____________________________,

This letter is to inform you that I will be visiting your son/daughter

___________________________________________ (name of the child) at your home
as stated in the above address at ____________________ (time) on
__________________________ (date) as part of our Curriculum. I’m teacher
___________________________________, the teacher of your son/daughter here at
_____________ School.
The purpose of the visit is to get to know and your child and discuss some important
information; the visit should only last 20-30 minutes.
I am available on _______________________ (date) between ______________(TIME)
AM/PM.
Do any of these days and times work for you?
Thank you in advance for allowing me to visit and the warm welcome in your home.

Sincerely,

_________________
Class Adviser

Approved:

___________________
School Principal

……………………………………………………………………………………………………
Pupil’s Name: ________________________________________________
Parent’s Name: _______________________________________________
Relationship to pupil: ___________________________________________
______ Yes, please free to contact us by: Cellphone Number: ____________________
______ No, (Reason) ____________________________________________________
______________________________________________________________________
 Republic of the Philippines
Department of Education
Region VI- Western Visayas
Schools Division of Antique
District of San Jose

CERTIFICATE OF APPEARANCE
This is to certify that ___________________________________ who is an
employee of DepEd- _________ School has personally appeared at my residence for
the purpose of HOME VISITATION from _____________ to ___________ (time) dated
__________________________.

This certification is being issued upon the request of ______________________

In compliance with the IPCRF and as part of Curriculum by the purpose of establishing
the evidence and duration of her appearance here at, the truth of which vouchsafed and
guaranteed by the undersigned.

________________________________________
Name of Parent/Guardian with Signature over Printed Name

Republic of the Philippines

Department of Education
Region VI- Western Visayas
Schools Division of Antique
District of San Jose

Please be informed that __________________________________ a teacher adviser of

(Name of Teacher)
__________________________, _________ School is allowed to conduct a
(Grade Level and Section)
Home Visitation with her pupil _____________________________________________
(Name of the Pupil)
For the reason _________________________________________________________
(State reason of Home Visitation)
This permit is issued ____________________ day of ___________________, 2023.

__________________________________
(Printed Name over Signature of the Parent/Guardian)

_____________________
School Principal
 Republic of the Philippines
Department of Education
Region VI- Western Visayas
Schools Division of Antique
District of San Jose

HOME VISITATION FORM

GRADE VI

Name of Pupil: _____________________________________________

Learner’s Reference Number: __________________________________________

Address : _____________________________________________

Name of Father: _______________________________________________

Work of Father: ________________________________________________

Name of Mother: ________________________________________________

Work of Mother: ________________________________________________

Contact Number/s: ________________________________________________

HOME VISIT RATIONALE:

Communicate with parents for pupil’s Performance Factor

Follow –up pupil’s Reading Ability

Investigate some causes about pupil’s late/absent

Finding factors of behaviour showed in school

Getting to know more of pupil’s family

REMARKS/AGREEMENT:

______________________________________________________________________

______________________________ ________________________________
Parent’s Signature over Printed Name Parent’s Signature over Printed Name