To: Sacred Heart Academy,

We have carefully read and thoroughly understood the

contents of SHAN STUDENT HANDBOOK (Revised
2019). We pledge our trust and confidence to SHAN and
abide by its rules and regulations.

Name Signature

Father (Print Name) Lito A. Petonio

Mother (Print Name) Editha D. Petonio

Guardian (Print Name) Janine D. Petonio

Student (Print Name) Kurt Justin D. Petonio

Grade/Section 11–ABM, GAS & HUMMS B2 Date 08- -2022

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 ACKNOWLEDGEMENT RECEIPT
PARENT/STUDENT AGREEMENT
I have received and read the ELECTRONIC DEVICE POLICY that
describes the guidelines, discipline policies, regulations, rules, and
expectations to be followed by students enrolled at SACRED HEART
ACADEMY OF NOVALICHES. My child and I have discussed these polici\
es and understand that we must comply to it.

As the parent or legal guardian of the student whose signature is

affixed below, I grant permission to my child to bring electronic device for
educational purposes only. I understand that my child may be held
liable for violations. I acknowledge that the school and its staff are
not responsible for any damage or loss of my child’s device. I also
understand that our consent will remain in effect for the duration of
our student’s attendance at SACRED HEART ACADEMY OF
NOVALICHES

Student’s Signature/Date

Parent/Guardian’s Signature/Date

Cell Phone Number

Parent’s Email Address

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