Republic of the Philippines

Department of Education
REGION III CENTRAL LUZON
SCHOOLS DIVISION OF TARLAC PROVINCE
CAPAS NATIONAL HIGH SCHOOL
SENIOR HIGH SCHOOL
DOLORES CAPAS TARLAC
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PARENTAL CONSENT

Instruction : Please complete the following. Sign and return to the work – immersion teacher.

Name of student : Maxine Faith Y. Cunanan__________________ Sex : F Age: 18

Name of Parent/Guardian: Jenny Solomon

Complete Address : Sitio Maligaya, Cutcut 1st Capas, Tarlac City

Cellphone number of the Parent/Guardian : 09359775621

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Emergency contact details: (if different from above)

Name: _________________________ Telephone No: ____________________________________

Relationship to child : _________________________________________