Republic of the Philippines

Department of Education
Region IV-A CALABARZON
Quezon National High School
Ibabang Iyam, Lucena City

PARENT’S / GUARDIAN’S CONSENT FORM

Name of Learner: _____________________________________________________ Date of Birth: _______________________

Parent’s/Guardian’s Name: ____________________________________ Relationship to Learner: ________________
Home Address: ________________________________________________________________________________________________
Contact Number/s: _____________________________________________________
TITLE OF THE ACTIVITY: SWIMMING LESSON/PRACTICAL
VENUE: QNHS SWIMMING POOL @ALCALA SPORTS COMPLEX
Date of Activity: MARCH 13,- 17 & MARCH 20- 24, 2023

As the parent/guardian of the abovementioned learner, I hereby acknowledge that I have

been informed of the details of the swimming lesson activity as part of their curriculum
Furthermore, I understand the risks associated with this activity and agree that the rules and
regulations established for the said activity are for the safety and security of the participants, and
thus agree to instruct my child to obey them.

Having understood all the aforementioned, I hereby consent to allow my child to

participate, acknowledging all of the foregoing. I am also solely responsible for providing travel
insurance and any expenses for my child’s participation.

___________________________________________________ ___________________________________________________
Parent/Guardian’s Name and Signature Date

Note: ( other information you may inform the teacher, such as child’s medical condition, etc.)

Republic of the Philippines

Department of Education
Region IV-A CALABARZON
Quezon National High School
Ibabang Iyam, Lucena City

PARENT’S / GUARDIAN’S CONSENT FORM

Name of Learner: _____________________________________________________ Date of Birth: _______________________

Parent’s/Guardian’s Name: ____________________________________ Relationship to Learner: ________________
Home Address: ________________________________________________________________________________________________
_______________________________________________ Contact Number/s: ___________________________________________
TITLE OF THE ACTIVITY: SWIMMING LESSON/PRACTICAL
VENUE: QNHS SWIMMING POOL @ALCALA SPORTS COMPLEX
Date of Activity: MARCH 13,- 17 & MARCH 20- 24, 2023

As the parent/guardian of the abovementioned learner, I hereby acknowledge that I

have been informed of the details of the swimming lesson activity as part of their curriculum
Furthermore, I understand the risks associated with this activity and agree that the rules and
regulations established for the said activity are for the safety and security of the participants, and
thus agree to instruct my child to obey them.

Having understood all the aforementioned, I hereby consent to allow my child to

participate, acknowledging all of the foregoing. I am also solely responsible for providing travel
insurance and any expenses for my child’s participation.

___________________________________________________ ___________________________________________________
Parent/Guardian’s Name and Signature Date
Note: ( other information you may inform the teacher, such child’s medical condition, etc.)