Republic of the Philippines

Department of Education
REGION VI- WESTERN VISAYAS
SCHOOLS DIVISION OF BAGO CITY
NAJABA ELEMENTARY SCHOOL-TABUCOL EXTENSION
SITIO TABUCOL, BRGY. BACONG-MONTILLA, BAGO CITY
(ENCLOSURE No. 2 to Division Memorandum No. ___ s 2023)

PARENT’S CONSENT FORM

Name of Learner : _____________________________________________________________________

Date of Birth : ___________________________ Sex : ________________________
Parents/Guardian Name : _____________________________________________________________________
Relationship to Learner : _____________________________________________________________________
Home Address : _____________________________________________________________________
Contact Numbers : _____________________________________

This form confirms that I/WE agree to allow the participation of my son/daughter in the NATIONAL
LEARNING RECOVERY PROGRAM (NLRC) in the Department of Education for 5 (FIVE) WEEKS starting on
July 24, 2023, at Najaba Elementary School-Tabucol Extension, SDO Bago City, Bago City.

As the parent/guardian of the above-mentioned learner, I hereby acknowledge that I have been informed of the
details of the off-campus activity and voluntarily and freely to participate in this off-campus activity.
Furthermore, I understand the risks associated with an off-campus 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 aforementioned, I hereby consent to allow my child to participate, acknowledging all of
the foregoing.

This is also to confirm that WE give full permission in any documentation that may be done during the conduct
of this activity and to use some or all their images or contribution in any publication (including electronic
publications such as film or website) created by the organizers or for the use of National Learning Camp and to
release this material to DepEd Official Platforms.

I hereby confirm that I agree and understand the commitment of my son/daughter as a participant of NLC. I
also understand and will support my son’s/daughter’s endeavor to meet the expectations, guidelines, and
responsibilities to his/her fellow students and to the National Learning Camp.

_________________________________________________
Name and Signature of Parents/Guardian

Date signed: ______________________________

NAJABA ELEMENTARY SCHOOL-TABUCOL EXTENSION

Sitio Tabucol, Brgy. Bacong-Montilla, Bago City
Email : NajabaESTabucolExt@gmail.com