Republic of the Philippines

DEPARTMENT OF EDUCATION
_____________IV-A___________
(Region)
___________Batangas________
(Division)
Sambat Elementary School
(School)
Sambat San Pascual Batangas
(School Address)

August 9,2019
Date

PARENT’S CONSENT

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

my/our son/daughter Sam Cyrel M. Frogosa in Football 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.

ROMNICK F. FROGOSA ROWENA A. MENDEZ

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

Signature of Guardian over Printed Name

(Relationship with the Athlete)

ROWENA I. TALLADA BENILDA MARANAN DALAWAMPU

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)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
_____________IV-A___________
(Region)
___________Batangas________
(Division)
Sambat Elementary School
(School)
Sambat San Pascual Batangas
(School Address)

August 9,2019
Date

PARENT’S CONSENT

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

my/our son/daughter Jed Gabriel G. Malaso in Football 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.

JOEVEN B. MALASO JENNIFER MONICA F. GARCIA

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

Signature of Guardian over Printed Name

(Relationship with the Athlete)

MARJORIE P. PEREZ BENILDA MARANAN DALAWAMPU

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)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
_____________IV-A___________
(Region)
___________Batangas________
(Division)
Sambat Elementary School
(School)
Sambat San Pascual Batangas
(School Address)

August 9,2019
Date

PARENT’S CONSENT

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

my/our son/daughter Reagan Carsten G. Brucal in Football 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.

REYNALDO P. BRUCAL CRISTY G. BRUCAL

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

Signature of Guardian over Printed Name

(Relationship with the Athlete)

ROWENA I. TALLADA BENILDA MARANAN DALAWAMPU

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)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
_____________IV-A___________
(Region)
___________Batangas________
(Division)
Sambat Elementary School
(School)
Sambat San Pascual Batangas
(School Address)

August 9,2019
Date

PARENT’S CONSENT

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

my/our son/daughter Lord Andrie D. Dinglasan in Football 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.

FERNANDO M. DINGLASAN LORNA B. DIMAYUGA

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

Signature of Guardian over Printed Name

(Relationship with the Athlete)

ROWENA I. TALLADA BENILDA MARANAN DALAWAMPU

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)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
_____________IV-A___________
(Region)
___________Batangas________
(Division)
Sambat Elementary School
(School)
Sambat San Pascual Batangas
(School Address)

August 9,2019
Date

PARENT’S CONSENT

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

my/our son/daughter Jim Maverick L. Dimatatac in Football 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.

REXY L. DIMATATAC
Signature of Father Over Printed Name Signature of Mother Over Printed Name

Signature of Guardian over Printed Name

(Relationship with the Athlete)

MARJORIE P. PEREZ BENILDA MARANAN DALAWAMPU

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)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
_____________IV-A___________
(Region)
___________Batangas________
(Division)
Sambat Elementary School
(School)
Sambat San Pascual Batangas
(School Address)

August 9,2019
Date

PARENT’S CONSENT

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

my/our son/daughter Rhenz Thanley F. Salazar in Football 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.

UNIVERT M. SALAZAR MARLYN F. SALAZAR

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

Signature of Guardian over Printed Name

(Relationship with the Athlete)

REMEDIOS T. VALDEZ BENILDA MARANAN DALAWAMPU

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)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
_____________IV-A___________
(Region)
___________Batangas________
(Division)
Sambat Elementary School
(School)
Sambat San Pascual Batangas
(School Address)

August 9,2019
Date

PARENT’S CONSENT

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

my/our son/daughter Nathan S. Rejuso Football 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.

JONATHAN A. REJUSO JANINE L. SAET

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

Signature of Guardian over Printed Name

(Relationship with the Athlete)

REMEDIOS T. VALDEZ BENILDA MARANAN DALAWAMPU

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)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
_____________IV-A___________
(Region)
___________Batangas________
(Division)
Sambat Elementary School
(School)
Sambat San Pascual Batangas
(School Address)

August 9,2019
Date

PARENT’S CONSENT

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

my/our son/daughter King Angel M. Fedelicio in Football 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.

REY L. FEDELICIO CRISTINE L. MAOG

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

Signature of Guardian over Printed Name

(Relationship with the Athlete)

REMEDIOS T. VALDEZ BENILDA MARANAN DALAWAMPU

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)