Republic of the Philippines

Department of Education
Region V - Bicol
Schools Division Office of Albay
CULLAT ELEMENTARY SCHOOL
Cullat, Daraga, Albay

PARENTAL CONSENT FORM

Name of Learner: _________________________________________________________

Date of Birth: _____________________________________ Sex: ________________
Parent’s/Guardian’s Name: _______________________________________________
Relationship to Learner: ___________________ Contact Number: _________
Home Address: ___________________________________________________________
Title of the Activity: National Learning Camp 2024
School: ________________________________ Duration of the Activity: _________

I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter, whose name has been mentioned above, in the National Learning Camp from
July 1-19, 2024.

I have considered the benefits that my son/daughter will get from his/her participation
in this activity provided that due care and precautions will be observed to ensure the comfort
and safety of my son/daughter.

Further, I understand the risks associated with the activity and agree that the rules and
regulations established for the said activity are for the safety and security of the participants,
and thus instruct my child to follow them. DepEd employees and personnel may not be held
responsible for any untoward incident that may happen beyond their control.

_____________________________ ___________________________
Signature of the Father Signature of the Mother
over Printed Name and Date over Printed Name and Date

___________________________________
Signature of the Guardian
over Printed Name and Date

Verified by: _______________________________ Date: _______________

Name of the Teacher