Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV – A CALABARZON
Division of Cavite
PUEBLO DEL MAR NATIONAL HIGH SCHOOL
Freedomville Subd., Bucana Sasahan, Naic, Cavite

JULY 22, 2019

Date

PARENT’S CONSENT

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

my/our son/daughter MARK REY D. JURILLA in BASEBALL in all School
Sports Meets up to the Palarong Pambansa.

I/We have considered the benefits that my son or daughter will derive from
his/her participation in this activity provided that due care, diligence and
necessary precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to

collect, process, retain, and dispose of personal information of the above-
mentioned athlete in accordance with the Data Privacy Act of 2012.

REYLAN M. JURILLA REBECCA D. JURILLA

Signature of Father Over Printed Name Signature of Mother Over Printed Name

Signature of Guardian over Printed Name

(Relationship with the Athlete)

RUSTAN C. TALICOL EVEE B. ADRA

Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)

Remarks:

Note:
If No Parent/s, submit Affidavit of Guardianship duly verified by the coach and teacher.
If parents are abroad, Special Power of Attorney (SPA) is needed.

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)