Appendix A

Republic of the Philippines

Department of Education
Region VIII (Eastern Visayas)
Schools Division of Leyte
TABANGO NATIONAL HIGH SCHOOL
Tabango, Leyte

PARENT/GUARDIAN IMMERSION CONSENT FORM

Name of student: _____________________ Age: ____________

Name of Parent/Guardian: ________________________________

Address: ___________________________________
Mobile: ____________________________________

_____________________________________________________________________
Emergency contact details: (If different from above)

Name: ……………………………………………………………… Telephone no: ……………..…………

Relationship to child: ……………………………………………………………………………….................

CONSENT (please read carefully)

a) I agree to my son/ daughter taking part of the Immersion Program as

requirement of the SHS Curriculum to expose the students to the assigned
company/units and learn new skills relevant to the theory learned in the
classroom
b) I fully support the Work Immersion undertaking of my son/daughter through
minimal financial cost; securing/paying for the Medical Insurance and other
requirements through my attendance/presence if so desired.
c) I consent my son/ daughter travelling by any form of public transport,
minibus or motor vehicle in the course of his/her Work Immersion.
d) I understand that my son/daughter will undergo an 80 hours/ 2 weeks/10
days Immersion to the assigned company/unit with corresponding School
coordinator and In-Company Trainer.

Signed ………………………………….....................… __________________

(Parent/ Guardian)

Date: ……………………………

Tabango, Leyte 6536

(053) 551 0014
https://tnhs_tabango.com.ph/