Republic of the Philippines

Department of Education
Region VIII – Eastern Visayas
Division of Southern Leyte
Hinunangan East Central School
Poblacion, Hinunangan, Southern Leyte

PARENTAL CONSENT

I ____________________________________________, and

_____________________________________________________
[Name of FATHER / Guardian] [Name of MOTHER]

hereby willingly and voluntarily give consent of my/our son/daughter/relative

_________________________________________________ to participate in the implementation of
[Name of SON / DAUGHTER / Relative]

Limited Face to Face classes in any of the following schedules as set by the school management;

 Class A: Half-day face-to-face classes in one straight week and other half-day for
distance learning
 Class B: One straight week of distance learning
 Students shall alternately attend face-to-face classes every week for the whole duration
of pilot implementation

I/We have understood and considered that safety and well-being of my/our
son/daughter/relative remain as a topmost priority as declared in these conditions:

1. Due care and precaution will be undertaken in accordance with health standards set by DOH
and Municipal Inter-Agency Task Force (MIATF) as measures to prevent the spread of COVID-19.
2. Observe health protocols in entering school premises by washing hands or with the use of
sanitizers, wearing of face mask, taking of body temperature and social distancing to ensure the
safety of all.
3. Upon entering the classroom/laboratory workshops my/our son/daughter/relative must submit
to the teacher his/her Health Declaration Form and stay at the specific place provided for by the
teacher.
4. I/We will be notified anytime of the condition that may arise along the implementation of this
face-to-face classes relative to Covid - 19 transmission. (Parents will provide a cellphone number
to the teachers)
5. DepEd employees may not be held responsible for any untoward incident that may happen
beyond their control.

Signature of Parents/Guardian:

________________________________________ _______________________________________
[Printed Name & signature of FATHER] [Printed Name & signature of MOTHER]

________________________________________ __________________________________
[Printed Name & signature of Guardian] Date
 Republic of the Philippines
Department of Education
Region VIII – Eastern Visayas
Division of Southern Leyte
LILOAN NATIONAL TECHNICAL VOCATIONAL HIGH SCHOOL
Poblacion, Liloan, Southern Leyte

PARENTAL CONSENT

I ____________________________________________, and
_____________________________________________________
[Name of FATHER / Guardian] [Name of MOTHER]

hereby willingly and voluntarily give consent of my/our son/daughter/relative

_________________________________________________ to participate in the implementation of
[Name of SON / DAUGHTER / Relative]

Expanded Face to Face classes in any of the following schedules as set by the school management upon
the approval of DepEd key Officials;

 Class A: Half-day face-to-face classes in one straight week and other half-day for
distance learning
 Class B: One straight week of distance learning
 Students shall alternately attend face-to-face classes every week for the whole duration
of pilot implementation

I/We have understood and considered that safety and well-being of my/our
son/daughter/relative remain as a topmost priority as declared in these conditions:

6. Due care and precaution will be undertaken in accordance with health standards set by DOH
and Municipal Inter-Agency Task Force (MIATF) as measures to prevent the spread of COVID-19.
7. Observe health protocols in entering school premises by washing hands or with the use of
sanitizers, wearing of face mask, taking of body temperature and social distancing to ensure the
safety of all.
8. Upon entering the classroom/laboratory workshops my/our son/daughter/relative must submit
to the teacher his/her Health Declaration Form and stay at the specific place provided for by the
teacher.
9. I/We will be notified anytime of the condition that may arise along the implementation of this
face-to-face classes relative to Covid - 19 transmission. (Parents will provide a cellphone number
to the teachers)
10. DepEd employees may not be held responsible for any untoward incident that may happen
beyond their control.

Signature of Parents/Guardian:

________________________________________ _______________________________________
[Printed Name & signature of FATHER] [Printed Name & signature of MOTHER]
________________________________________ November 27, 2021
[Printed Name & signature of Guardian] Date