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Republic of the Philippines

Department of Education
REGION V
SCHOOL DIVISION OF MASBATE PROVINCE
Enclosure No. 4 Division Memorandum No.___, s. 2020

PARENTAL CONSENT and COMMITMENT FORM FOR ACADEMIC


REINFORCEMENT/ENRECHMENT PROGRAM SHIELD II

_____________________
(Date)

I, _________________________________ hereby state that I am the ______________________ of


(Name of Parent or Guardian) (Relationship to the learner)
________________________ do hereby signify my consent to my child to participate in the
(Name of the Learner)
ACADEMIC REINFORCEMENT ENRICHMENT PROGRAM SHIELD II through ____ ONLINE/
___ OFFLINE Learning Engagement from June 15, 2020 to August 7, 2020 offered by
_____________________________________.
(Name of School)

________________________________________
(NAME & SIGNATURE OF PARENT/GUARDIAN)

Address : Rodeo Road, Brgy. Centro, Masbate City


Telephone No. : (056)578-2544
Email Add : masbate@deped.gov.ph
Website : http://depedmasbate.ph

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