Republic of the Philippines

Province of La Union
Municipality of Bauang
OFICE OF THE MUNICIPAL WELFARE AND DEVELOPMENT

CONSENT FOR THE PROVISION OT THE DAY CARE SERVICE

WE/I, _________________________ and _____________________________
(Father/guardian) (Mother/Guardian)
Of legal age/s, resident of ACAO, BAUANG LA UNION are/is the parents/guardians of the
minor, ___________________________________________________________.
That the said minor, ________________________________ was born on
_____________________________ at _______________________________________.
That minor is found to be eligible for DAY CARE SERVICE and referred to GUERRERO
CHILD DEVELOPMENT CENTER by HAIDI R. MEANA for the period of
_____________________________________________.
That we consent to the provision of said service to our child for the stated period
herein;
That we will provide support in the different activities and continue such activities
at home in order to attain the objectives of the DAY CARE SERVICE for the welfare of our
child;
That we will report any difficulties/ problems to the SOCIAL WORKER/ CHILD
DEVELOPMENT WORKER and cooperate with them to solve said problems;
That this consent was explained to us and we fully understand its implications.
Issued on________________________________ at GUERRERO CHILD DEVELOMENT
CENTER.

____________________________ ___________________________
SIGNATURE OF FATHER SIGNATURE OF MOTHER

WITNESSES:
HAIDI R. MEANA ARLIE R. ALONZO,RSW
CHILD DEVELOPMENT WORKER LSWDO