Republic of the Philippines

Department of Education
REGION IV A - CALABARZON
SCHOOLS DIVISION OF RIZAL

SAN MATEO NATIONAL HIGH SCHOOL

SAN MATEO, RIZAL

PARENTAL CONSENT FORM

Name of Learner: _____________________________________________________ Sex: _________________

Parent’s/Guardian’s Name: _________________________________________________________________
Relationship to the Learners: ________________________________________________________________
Home Address: _____________________________________________________________________________
Contact Number/s: _________________________________________________________________________
Title of the Activity: Leadership Training of SMNHS Student Leaders_____________________________
Venue: San Mateo National High School_____________________________________________________
Date of Activity: Dec. 2, 2023_________________________________________________________________
Time of Activity and Composition of Participants:
8:00am-12:00noon (composed of SSLG Officers, G7 and G10 Class Presidents/Officer if the president is not available)
1:00pm-5:00pm (composed of School Club Presidents, G8 and G9 Class Presidents)

As the parent/guardian of the abovementioned learner, I hereby acknowledge that I have been informed of the
details of the activity and voluntarily and freely elect to participate in this activity. Furthermore, I understand the risks
associated with this activity and agree that the rules and regulations established for the said activity are for the safety and
security of the participants, and thus agree to instruct my child or children to obey them.

Having understood all the aforementioned, I hereby consent to allow my child/children to participate,
acknowledging all of the foregoing.

______________________________________ ___________________________
Parent’s/Guardian’s Name Date
and Signature