Republic of the Philippines

Department of Education
REGION VI-WESTERN VISAYAS
SCHOOLS DIVISION OF ILOILO
Luna, La Paz, Iloilo City

PARENT CONSENT FORM

I am permitting my child, (Name) ____________________________of (School)

_______________________________, to participate in the Division YES-O Camp 2023
on June 10-11, 2023 at Barotac Viejo National High School, Barotac Viejo, Iloilo.

I am aware of the usual risks and dangers entailed by the said activity and
acknowledge that accidents can occur with or without any fault on either the part
of the student, or the teachers and organizers where the activity is taking place.

By allowing my child to participate, I accept the risks and the possibility of any
untoward incident. Therefore, I hereby voluntarily release and discharge the
organizers from any and all claims, demands, or causes of action, which are
connected with my child's participation in this event.

I am permitting the organizers to take photographs and videos during the activities
involving my child for documentation purposes. I understand that when my child is
participating in this event, s/he will be under the supervision and control of the
organizers. I am also aware that for the accommodations, my child will be roomed
with students of the same gender and age group.

I understand that I will be notified should a medical emergency arise. If I cannot be

reached by phone call, I authorize whatever medical treatment is deemed necessary
by the health personnel. I hereby attest that my child’s attendance and involvement
in this activity is voluntary and that I have read (or have been read to me) the
contents of this form, understand it, and sign it voluntarily.

*If your child suffers from any allergy,

medical problem, or disability which may
affect her/his participation during the
activity or if you have any information
which you think we should be aware of,
please provide the details below.

________________________________________

________________________________________

Parent’s/ Guardian’s Name ___________________________________________

Signature _________________________________

Contact Number ___________________________

Date ____________________________

Republic of the Philippines

Department of Education
REGION VI-WESTERN VISAYAS
SCHOOLS DIVISION OF ILOILO
Luna, La Paz, Iloilo City