Republic of the Philippines

Department of Education
Region III- Central Luzon
Schools Division Office of Pampanga
STA ANA NATIONAL HIGH SCHOOL
San Agustin Sta. Ana, Pampanga

Participant’s Consent Form

Name of Participant: Mark John M. Atoy
Date of Birth: July 13, 1994
Sex: Male
Home Address: 114 San Bartolome Santa Ana, Pampanga
Contact Number/s: 09684680522
Title of the Activity: Gender and Development
Venue: Dingalan StressFree Resort and Hotel, Dingalan, Aurora.
Date of Activity: July 05 - 06 2024

As a participant, 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 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 obey them.

Having understood all the aforementioned, I hereby consent to participate, acknowledging all of
the foregoing.

Mark John M. Atoy April 29, 2024

Participant’s Name and Signature Date