Revised as of September 26, 2019

Republic of the Philippines

DEPARTMENT OF EDUCATION
x
(Region)
DIVISION OF MISAMIS ORIENTAL
(Division)
LUZ BANZON INTEGRATED SCHOOL
(School)
LUZ BANZON JASAAN MISAMIS ORIENTAL
(School Address)

OCT.19, 2023
Date

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of

my/our son/daughter ____________________________ in School
Intramurals this coming Oct. 20, 2023 @ Luz Banzon Intgerated School
ground.

I/We have considered the benefits that my son or daughter will derive
from his/her participation in this activity provided that due care, diligence and
precautions will be observed to ensure the comfort and safety of my
son/daughter and that DepEd Employees and Personel may not be held
responsible for nay untoward incident that may happen beyond their control.

Signature of Father Over Printed Name Signature of Mother Over Printed Name

______________________
Signature of Guardian over Printed Name

_______________________
Relationship with the pupil

Verified:

Adviser School Head/Registrar

(Signature Over Printed Name) (Signature Over Printed Name)

Remarks:

Note:
Submit the necessary documents, i.e. Affidavit/Sworn Statement of Actual Care and Custody
duly verified by the adviser and school head, in cases signature of parents are unavailabl