Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE 1 PANGASINAN
300205 Garrita National High School
Garrita, Bani, Pangasinan

Would you allow your child to participate and attend the limited face to face in school
of Garrita National High School? (Kindly encircle 1 of the choices only)
 Yes
 No

If your answer is No, kindly specify your reason. ____________________________

PARENTAL CONSENT AND WAIVER FORM

I, ____________________________________ parent of
___________________________________ who is a Grade ____________ student in
GARRITA NATIONAL HIGH SCHOOL, GARRITA BANI,PANGASINAN, hereby
willingly and voluntarily consent the participation of my son/daughter to attend his/her
limited face-to-face classes starting April 8, 2022 of Academic Year 2021 – 2022 and
onwards.

I have considered the benefits that he/she will derive from his/her participation in the limited
face to face classes with the understanding that I will not hold any party responsible for any
untoward accident and or incident which may happen to my son/daughter during the above
mentioned Academic classes as long as due care and precautions are observed to ensure the
safety of the learners.

I hereby affix my signature this _____ day of ____________ at _______________,

Pangasinan.

________________________________________
Parent’s/Guardian’s Signature over Printed Name

Contact Number: __________________________