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    Parent Consent

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    Dwight Roberts
    This document is a parental consent form for a senior high school student's work immersion program. It requests information about the student such as name, age, parent/guardian details, and any medical conditions. The parent consents to the student participating in the work immersion program, which is a Department of Education requirement. They confirm the student has no medical conditions other than what is listed. The parent acknowledges guidelines for work immersion and that safety precautions will be followed, but teachers and institutions cannot be held responsible for incidents beyond their control. Minimum health protocols will also be observed during work immersion. The parent signs the form, providing their address, phone numbers, and email.

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    Parent Consent

    Uploaded by

    Dwight Roberts
    14 views1 page
    This document is a parental consent form for a senior high school student's work immersion program. It requests information about the student such as name, age, parent/guardian details, and any medical conditions. The parent consents to the student participating in the work immersion program, which is a Department of Education requirement. They confirm the student has no medical conditions other than what is listed. The parent acknowledges guidelines for work immersion and that safety precautions will be followed, but teachers and institutions cannot be held responsible for incidents beyond their control. Minimum health protocols will also be observed during work immersion. The parent signs the form, providing their address, phone numbers, and email.

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    PARENT CONSENT

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    This document is a parental consent form for a senior high school student's work immersion program. It requests information about the student such as name, age, parent/guardian details, and any medical conditions. The parent consents to the student participating in the work immersion program, which is a Department of Education requirement. They confirm the student has no medical conditions other than what is listed. The parent acknowledges guidelines for work immersion and that safety precautions will be followed, but teachers and institutions cannot be held responsible for incidents beyond their control. Minimum health protocols will also be observed during work immersion. The parent signs the form, providing their address, phone numbers, and email.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    14 views1 page

    Parent Consent

    Uploaded by

    Dwight Roberts
    This document is a parental consent form for a senior high school student's work immersion program. It requests information about the student such as name, age, parent/guardian details, and any medical conditions. The parent consents to the student participating in the work immersion program, which is a Department of Education requirement. They confirm the student has no medical conditions other than what is listed. The parent acknowledges guidelines for work immersion and that safety precautions will be followed, but teachers and institutions cannot be held responsible for incidents beyond their control. Minimum health protocols will also be observed during work immersion. The parent signs the form, providing their address, phone numbers, and email.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Republic of the Philippines

    Department of Education
    Region VIII
    Division of Tacloban City
    JE Mondejar Computer College

    SENIOR HIGH SCHOOL WORK IMMERSION PARENTAL CONSENT FORM


    Instruction: Please fill all necessary information and return to the Work Immersion Focal
    Person/ Adviser on or before deadline.
    Name of Student: __________________________________________ Age: ____________
    Name of Parent/ Guardian: _____________________________________________________
    Relationship to the Student: ____________________________________________________
    Complete Address: ___________________________________________________________
    Mobile Number: _____________________________________________________________
    Does your child suffer from any medical conditions/ 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 for 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 does not suffer from any
    medical condition other than those listed above.
    3. I am fully aware of the content of the DepEd Order 30 s2017 (Guidelines for Work
    Immersion) and DM- CI- 2020- 0 00 85 (Guidelines for Work Immersion
    Implementation During Crisis Situation)
    4. I have considered the benefits that my son / daughter will derive from his/ 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.
    5. I am fully aware that the Minimum Health Protocol will be properly observed during
    the duration of the Work Immersion.

    Signed:

    __________________________________________
    Name of Parent/ Guardian Over Printed Name

    Address: Brgy. 71, Naga- naga, Tacloban City


    Telephone Number: 321-5883*321-3249*327-9558
    Email: info@mondejar.edu

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