Republic of the Philippines

Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OF CITY OF SAN PEDRO
DISTRIC II

PARENTS / GUARDIAN CONSENT

This is to permit my/ our child/ ward, _________________________________________________, to have his/her

( name of student)
80 – hour STEM related Work Immersion at__________________________________________________________
( name of company/ institution)
_______________________________________________________________________________________________,
_______________________________________________________________________________________________
( company address )

I expressly waive any and all claims against the school, the company, and or its representative on the account of any
incident/ injury or damage to personal property that may occur beyond the control of the work immersion teacher and
supervisor provided that adequate safety measures and precautions have been instituted in connection with the
participation of my/ our child/ ward in the above mentioned activity.

______________________________________________ __________________________________________
Signature of Father/ Guardian over printed name Signature of Mother/ Guardian over printed name

Pacita Complex Senior High School

Stand Alone SHS No. 19
Tirad Pass St. Pacita Complex, San Pedro Laguna
(02) 7720-5032 │342361@gmail.com