Republic of the Philippines

DEPARTMENT OF EDUCATION
Caraga Region
LUCENA NATIONAL HIGH SCHOOL
Lucena, Prosperidad, Agusan del Sur
Empowered Operating Unit
School ID. : 304722

PARENTAL CONSENT FOR WORK IMMERSION

I/We hereby willingly and voluntarily give consent to the participation of my/our son/daughter
________________________________________________ in the eighty (80) hours WORK
IMMERSION PROGRAM of Grade 12 PLATO(GAS) Students of Lucena National High School
starting in November 18, 2019. The said program Involves hands – on experience or work simulation in
which learners can apply their competencies and acquired knowledge relevant to their track

I understand that an insurance for learners in DepEd Schools shall be procured by their
respective schools, hence, I have considered the benefits that my son/daughter will derive from his/her
participation on the said Work Immersion Program provided that due care and precaution will be
observed to ensure the comfort and safety of my son/daughter and that I hereby release the school, its
teachers, and personnel from any and all liability, claims, demands and causes of action whatsoever
arising out of or related to any loss, damage, or injury that may be sustained by my son/daughter during
Work Immersion.

I have read and fully understood the statements above including the implication thereof.

Signature of Father Signature of Mother

Name of Father Name of Mother

Signature of Guardian over Printed Name

Relationship with the Learner

Date: ___________________