Revised as of September 26, 2019

Republic of the Philippines

DEPARTMENT OF EDUCATION
Region VI – Western Visayas
Division Of Aklan
New Washington National Comprehensive High School
Rizal St. Poblacion New Washington, Aklan

January 31, 2023

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter CARLITO R. ARGUILLES JR. in Taekwondo in all School Sports Meets
up to the Palarong Pambansa.

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 necessary
precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to collect,

process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.

CARLITO B. ARGUILLES CRESILDA R. ARGUILLES

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

Verified:

RODESSA P. ROLDAN MELANY S. NAZARETA, PhD

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 unavailable.

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Revised as of September 26, 2019
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI – Western Visayas
Division Of Aklan
New Washington National Comprehensive High School
Rizal St. Poblacion New Washington, Aklan

January 31, 2022

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter RAVEN R. RIVERA in Taekwondo in all School Sports Meets up to the
Palarong Pambansa.

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 necessary
precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to collect,

process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.

RODELIO P. RIVERA ROVELYN A. RIVERA

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

Verified:

JASPER MAE M. BLANCO MELANY S. NAZARETA, PhD

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 unavailable.

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

Revised as of September 26, 2019
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI – Western Visayas
Division Of Aklan
New Washington National Comprehensive High School
Rizal St. Poblacion New Washington, Aklan

January 31, 2022

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter RYAN N. TOLENTINO in Taekwondo in all School Sports Meets up to the
Palarong Pambansa.

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 necessary
precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to collect,

process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.

BRIAN T. TOLENTINO RONALIZA N. TOLENTINO

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

Verified:

MARJORIE ROSE Z. TEODOSIO MELANY S. NAZARETA, PhD

Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)

Remarks:
His mother is working in Manila.
Revised as of September 26, 2019

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 unavailable.

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI – Western Visayas
Division Of Aklan
New Washington National Comprehensive High School
Rizal St. Poblacion New Washington, Aklan

January 31, 2022

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter ROD RIAN M. IBABAO in Taekwondo in all School Sports Meets up to
the Palarong Pambansa.

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 necessary
precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to collect,

process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.

RICHEL M. IBABAO
Signature of Father Over Printed Name Signature of Mother Over Printed Name

TERESITA M. IBABAO
Signature of Guardian Over Printed Name

Verified:

JASPER MAE M. BLANCO MELANY S. NAZARETA, PhD

Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)

Remarks:
Revised as of September 26, 2019 The father is unknown and his mother is in
Manila .

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 unavailable.

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI – Western Visayas
Division Of Aklan
New Washington National Comprehensive High School
Rizal St. Poblacion New Washington, Aklan

January 31, 2022

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter ANTHONY JOHN L. JULIAN in Taekwondo in all School Sports Meets
up to the Palarong Pambansa.

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 necessary
precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to collect,

process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.

HENRY R. JULIAN JR. NORIBEL L. JULIAN

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

Verified:

RODESSA P. ROLDAN MELANY S. NAZARETA, PhD

Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)

Revised as of September 26, 2019

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 unavailable.

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI – Western Visayas
Division Of Aklan
New Washington National Comprehensive High School
Rizal St. Poblacion New Washington, Aklan

January 31, 2022

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter JAMES C. MASINDA in Taekwondo in all School Sports Meets up to the
Palarong Pambansa.

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 necessary
precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to collect,

process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.

JOSE GARY E. MASINDA MYRNA C. MASINDA

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

Verified:

MARIA CRISTINA MAE A. ABARICIO MELANY S. NAZARETA, PhD

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 unavailable.

January 31, 2022

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI – Western Visayas
Division Of Aklan
New Washington National Comprehensive High School
Rizal St. Poblacion New Washington, Aklan

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter THALIA EUNICE DIMO in Taekwondo in all School Sports Meets up to
the Palarong Pambansa.

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 necessary
precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to collect,

process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.

KRISTINE KAY T. DIMO

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

Verified:

SHIRLEY R. LINGACION MELANY S. NAZARETA, PhD

Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)

Remarks:
The father is unknown

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 unavailable.

January 31, 2023

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)

 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI – Western Visayas
Division Of Aklan
New Washington National Comprehensive High School
Rizal St. Poblacion New Washington, Aklan

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter _____________________________ in Taekwondo in all School Sports
Meets up to the Palarong Pambansa.

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 necessary
precautions will be observed to ensure his/her health and safety.

Further, I/We authorize the personnel of Department of Education to collect,

process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.

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

Verified:

MELANY S. NAZARETA, PhD

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 unavailable.

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)