Republic of the Philippines

Department of Education
Region IV-A CALABARZON
Schools Division Office of Rizal
San Mateo Sub-Office
MALY ELEMENTARY SCHOOL

PARENT’S/GUARDIAN CONSENT FORM

Name of Learner: ________________________________________________________________________________________________
Date of Birth: ____________________________________________________________Sex:________________________________
Parent’s/Guardian’s Name: ________________________________________________________________________________________
Relationship to Learner: ________________________________________________________________________________________________
Home Address: ________________________________________________________________________________________________
Contact Number/s: ________________________________________________________________________________________________
Title of the Activity: NCERIES THE SPACE SHOW SY 2023-
2024_________________________________________________________
Venue: MALY ELEMENTARY
SCHOOL_____________________________________________________________________
Date of Activity: APRIL 17,2024__________________________________________________________________________________

As the parent/guardian of the abovementioned learner, I hereby acknowledge that I have been informed of the details of the
on-campus activity and voluntarily and freely elect to participate in this on-campus activity. Furthermore, I understand the risk
associated with the activity and agree that the rules and regulations established for the said activity are for the safety and security of
the participants, and thus I agree to instruct my child or children to obey them.

Having understood all the aforementioned, I hereby consent to allow my child or children to participate, acknowledging all of
the foregoing, as I will not hold the school accountable. And I do hereby undertake to voluntarily pay the ticket amounting to
Php290.00. Thus, I will not hold the school or any of the officials accountable for the payment that I will voluntarily make for this
activity.

___________________________________ ___________________________________
Parent/Guardian’s Name and Signature Date

Republic of the Philippines

Department of Education
Region IV-A CALABARZON
Schools Division Office of Rizal
San Mateo Sub-Office
MALY ELEMENTARY SCHOOL

PARENT’S/GUARDIAN CONSENT FORM

Name of Learner: ________________________________________________________________________________________________
Date of Birth: ____________________________________________________________Sex:________________________________
Parent’s/Guardian’s Name: ________________________________________________________________________________________
Relationship to Learner: ________________________________________________________________________________________________
Home Address: ________________________________________________________________________________________________
Contact Number/s: ________________________________________________________________________________________________
Title of the Activity: NCERIES THE SPACE SHOW SY 2023-
2024_________________________________________________________
Venue: MALY ELEMENTARY
SCHOOL_____________________________________________________________________
Date of Activity: APRIL 17,2024__________________________________________________________________________________

As the parent/guardian of the abovementioned learner, I hereby acknowledge that I have been informed of the details of the
on-campus activity and voluntarily and freely elect to participate in this on-campus activity. Furthermore, I understand the risk
associated with the activity and agree that the rules and regulations established for the said activity are for the safety and security of
the participants, and thus I agree to instruct my child or children to obey them.

Having understood all the aforementioned, I hereby consent to allow my child or children to participate, acknowledging all of
the foregoing, as I will not hold the school accountable. And I do hereby undertake to voluntarily pay the ticket amounting to
Php290.00. Thus, I will not hold the school or any of the officials accountable for the payment that I will voluntarily make for this
activity.

___________________________________ ___________________________________
Parent/Guardian’s Name and Signature Date