Republic of the Philippines

Department of Education
REGION III – CENTRAL LUZON
SCHOOLS DIVISION OF CITY OF MEYCAUAYAN
ZAMORA ELEMENTARY SCHOOL
ZAMORA, CITY OF MEYCAUAYAN, BULACAN

PARENTAL CONSENT

Name of the Learner: _____________________________________________________________________________

Date of Birth: ______________________________________________ Sex: _________________________

Parent/Guardian Name: ___________________________________________________________________________

Relationship to the learner: ______________________________ Contact Number: _______________

Address: _______________________________________________________________________________________

Title of the Activity: Division School Press Conference

Venue: Meycauayan West Central Integrated School Date: November 3, 2023 Time:8:00mPm

As the parent/guardian of the above mentioned name, I hereby acknowledge that I have been
informed of the details of the off-campus activity and voluntarily and freely elect to participate in this off-campus
activity furthermore, I understand the risk associated the off-campus activity and agree that the rules and
regulations established for the said activity are for the safety and security of the participant and thus agree to
instruct my child to obey them.

Having understood of the aforementioned, I hereby consent to allow my child to participate,

acknowledging all the foregoing. I am also solely responsible for providing travel insurance and any expense for my
child’s participation in the activity.

Note: (other information you wish to inform the teacher, such as child condition, etc.)

___________________________

Signature Over Printed Name

PARENT/GUARDIAN
Verified by:

STELLA MARIS M. DUMALAY SYLVIE V. LEGARADA

SPA Adviser-English SPA Adviser-Filipino

Noted by:

MA. BENILDA M. MENDOZA

Teacher-In-Charge

Address: Ricabo St. Zamora, City of Meycauayan Bulacan

City of Meycauayan, Bulacan
Contact No. 09338626587
104938.meyc@deped.gov.ph