Republic of the Philippines

Department of Education
_____________I____________
(Region)
__________LA UNION___________

(Division)

PARENTAL

CONSENT

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

son/daughter ____
___________ in the Lower meets up to
Palarong Pambansa.
I have considered the benefits that my son/daughter will derive from his/her
participation in this activity with the understanding that due care and precaution will be observed to
ensure the comfort and safety of the delegation and that DepEd employees and personnel may not be
held responsible for any untoward incident that may happen beyond their control.

___________________________________

__________________________________

Signature of Father

__________

Signature of Mother

_________
Name of Father

__________

_______
Name of Mother

_____________________________________________________
Signature of Guardian over Printed name

_____________________________________________________
(Relationship with Athlete)

Verified by:

_________
Teacher - Adviser

________

____________________________
Principal/School Head/Registrar