PARENTAL CONSENT

I, ______________________________________, hereby acknowledge that my child’s participation

(Parent’s Name)
in ____________________________________________________ is completely voluntary. I freely
assume the said risk and I permit my child to attend and participate in the said activity
to be held at ________________________________________________ on ____________________.

I understand that my child’s in-person attendance will include associating with fellow
learners, teachers, and other persons inside and outside of the venue that may put my child
at risk of COVID-19 transmission, notwithstanding the precautions undertaken by the
organizers.

I confirm that my child currently has none of the symptoms of COVID-19 and is in good
health. I will not allow my child to physically attend the activity if my child or any member
of my household develops any of the COVID-19 symptoms or any other symptoms of illness
that may or may not be related to it.

I also consent my child’s image and appearance to be shown in social media and other
online platforms.

To the extent allowed by law and rules, I hereby agree to waive, release, and discharge any
and all claims, causes of action, damages, and rights against the organizers as well as
officials and personnel of the Department of Education relative to the conduct of the activity.

With full understanding, I – on behalf of myself, my household members, and my child –

hereby freely and voluntarily give my consent to my child’s participation in
________________________________________. I also attest that I had sought the views of my
child and he/she has expressed willingness to participate in the activity.

____________________________________________
(Signature of Parent/Guardian over Printed Name)

Contact number: ____________________________

Address: ____________________________________

Name of contestant/child: __________________________________

Date: __________________

Address: Luna St., La Paz, Iloilo City 5000

Tel./Fax No. (033) 320-1402 | (033) 320-0719 | (033) 320-0707 | (033) 327-2252
Website: http://www.depediloilo.ph | e-mail: iloilo@deped.gov.ph