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San Roque, Sogod, Southern Leyte

Email: president@southernleytestateu.edu.ph
Website: www.southernleytestateu.edu.ph

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DEPARTMENT OF TEACHER EDUCATION

PARENTS’ CONSENT

I/We, Mr. _____________________________________and Mrs.____________________________ parents of

__________________________________________, a prospective practice teacher of the Southern Leyte State
University-Main Campus ___________________________________________ have unto grant permission
him/her to undergo ________________hours of Practice Teaching in
_________________________________________ for Phase 1 and ____________________________________________ for
Phase II which is a requirement for graduation.

That we made it known our continued financial and moral support to him/her during
the internship. That we shall adhere to any disciplinary action of the school, such as dropping
him/her from the rolls of trainers and/or barring him/her from graduation should it be found
that he/she is a frequent absentee and/or notoriously undesirable trainee.

I/We voluntarily waive any claim against the school/supervisor-in-charge for any
untoward incident which may occur beyond control in the course of his/her
attendance/participation; after all precautionary measures and exhaustive effort have been
taken by the person-in-charge.

It is also fully known that we have read and understand all the contents of the parents’
consent and have signed with our voluntary act and deed.

Signed this _________day of __________________ 20________in ________________________________, Philippines.

_________________________ _____________________________
Signature of Parent/Guardian Signature of Practice Teacher

WITNESSES:

_______________________________
Practice Teaching Supervisor

Noted by: Conforme:

___________________________________________ _________________________________________________
Head, DTE Signature over Printed Name of Practice Teacher

SUBSCRIBED AND SWORN TO before me this ______day of __________________, 20______ at

_______________________________, Philippines

Doc. Code: SLSU-QF-IN07

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Revision: 01 https://www.facebook.com/southernleytestateu/
Date: 30 January 2019 https://www.youtube.com/c/SouthernLeyteStateUniversity