Republic of the Philippines
Department of Education
National Capital Region
Schools Division Office of Makati City
COMEMBO ELEMENTARY SCHOOL
Lanzones St., Comembo Makati City
CONSENT FORM
Name of Pupil/Student:
ELAYSIA REI L. LAGORZA
Grade Level:
KINDER
Name of Parent/Guardian:
MA. ELIZA L. LAGORZA
I hereby give my consent to COMEMBO ELEMENTARY SCHOOL and the designated teachers
of my child/ward to:
1. Conduct online interaction through whatever social media platforms with my
child/ward for any distance learning activities;
2. To keep a record of online interaction with my child/ward, whenever recording is
made;
3. To take snapshots/images/videos which may include my child’s/ward’s image for
documentation and other lawful purposes;
4. To post in the official school social media page/web page/private social media
group: the image, name, and section of my child/ward as well as any
acknowledgement/awards that he/she is entitled;
5. Other similar processing of information of my child/ward for any activities
sanctioned by DepEd.
SEPTEMBER 8, 2021
_____________________________
Date Signed
Lanzones St., Comembo Makati City
136692@deped.gov.ph
(02)7239 7430
MA. ELIZA L. LAGORZA
_________________________
Signature Over Printed Name