Republic of the Philippines

DEPARTMENT OF EDUCATION
IV-A CALABARZON
(Region)
BACOOR CITY
(Division)
St. Peregrine Institute
(School)
Banalo, Bacoor City, Cavite
(School Address)

Date: ______________

PARENT'S CONSENT

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

my/our son/daughter 0 , 0 0 in Volleyball- Boys

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.

0 0
Signature of Father over Printed Name Signature of Father over Printed Name

0
Signature of Guardian over Printed Name

ORLAN O. VENTURA RAINELDA R. DE GUZMAN

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)

Note:
Kapag Nanay at tatay ang pumirma- ok (idelete ang 0 s space for guardian)

Kapag nanay ang pipirma ay idelete ang name ng tatay dun s space for father(vice versa)
at idelete ang 0 dun s space for signature ng guardian

Kapag guardian ang pipirma ay idelete ang

name ng nanay at tatay. i-type ang name ng guardian s data entry
at papirmahan sa guardian. Need din na mag attach ng affidavit

of Guardianship na may pirma ng guardian at abogado at verified ng coach at teacher adviser

(Ito ay hiwalay na form)
Kapag guardian ang pipirma ay lalagyan ng remarks ang remarks box
(dahilan kung bakit hindi nakapirma ng parents)

Ang Parental Consent ay dapat verified ng both adviser (1) at

School head/ Registrar (2)

Kung ang Parents ay ngtatrabaho abroad kailangang magpasa ng special power of atty.
(magtanong n lang s abogado kung paano kumukuha dahil walang form n ibinigay)
Maaring irequire natin ito kung ang player ay maselect s Division meet/ Cluster meet

Sa a4 na papel ito ipiprint