Republic of the Philippines

Department of Education
Region III – Central Luzon
Schools Division of Tarlac Province
CIT COLLEGES OF PANIQUI FOUNDATION, INC.
Burgos St. Poblacion Norte, Paniqui, Tarlac 2307

Senior High School Work Immersion

(Parental Consent Form)
Instruction: Please fill all the necessary information and return to the Work Immersion Coordinator/Adviser on
or before the deadline.

Name of Student: ________________________________________________

Name of Parent/Guardian:__________________________________________
Relationship to the Student: ________________________________________
Complete Address: _______________________________________________
Mobile Number: _________________________________________________

Does your child suffer from any medical condition/allergies that the teacher/school/company should be aware of
(including any current medication)?
[ ] No [ ] Yes (please indicate)

………………………………………………………………………………………………………………………

Please provide details of medication that must be administered and attached a medical certificate.

………………………………………………………………………………………………………………………

CONSENT (please read carefully)

1. I willingly and voluntarily give consent to my son/daughter to be sent Work Immersion as part of the
requirement set by the Department of Education in the Senior High School.
2. I confirm to the best of my knowledge that my son/daughter through minimal financial cost and through
my attendance/presence if so desired.
3. I am fully aware of the content of the DepEd Order 30s2017 (Guidelines for Work Immersion) and
DM-C1-2020-00085 (Guidelines for Work Immersion Implementation During Crisis Situation).
4. I fully support the Work Immersion of my son/daughter through minimal financial cost and through my
attendance/presence if so desired.
5. I consent my son/daughter travelling by any form of public/private transport by land or water if needed as
long as it is within the scope of its activities and training.
6. I have considered the benefits that my son/daughter will derive his or her Work Immersion provided that
due care and precaution will be observed to ensure the comfort and safety of my son/daughter and that
teachers/School/company may not be held responsible for any untoward incident that may happen beyond
their control.
7. I am fully aware that the Minimum Health Protocol will be properly observed during the duration of Work
Immersion.

Signed:

Name of Parent/Guardian Over Printed Name: . .