4-parental-consent1

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SCIENCE AND TECHNOLOGY CENTER (STEC)
Basak, Lapu-Lapu City
SENIOR HIGH SCHOOL DEPARTMENT
PARENT/GUARDIAN IMMERSION CONSENT FORM
Instruction: Please complete the following, sign and return to:.
Mr. Bryant C. Acar, STEC Immersion Coordinator
Name of student: _____________________
Age: ____________
Name of Parent/Guardian: ________________________________
Address: ___________________________________
Mobile: ____________________________________
Family Doctor …………………………………………… Doctor’s Tel No: …………………………........
Does your child suffer from any medical conditions/allergies that the teacher/
trainer should be aware of (including any current medication
.........................................................................................................
Please provide details of medication that must be administered:
_____________________________________________________________________
Emergency contact details: (If different from above)
Name: ……………………………………………………………… Telephone no: ……………..…………
Relationship to child: ……………………………………………………………………………….................
CONSENT (please read carefully)
a) I agree to my son/ daughter taking part of the Immersion Program as
requirement of the SHS Curriculum to expose the students to the assigned
company/units and learn new skills relevant to the theory learned in the
classroom
b) I fully support the Work Immersion undertaking of my son/daughter through
minimal financial cost; securing/paying for the Medical Insurance & Uniform
and through my attendance/presence if so desired.
c) I consent to my son/ daughter travelling by any form of public transport,
minibus or motor vehicle by land or water in the course of his/her Work
Immersion.
d) I understand that my son/daughter will undergo an 80 hours/ 2 weeks/10
days Immersion to the assigned company/unit with corresponding School
coordinator and In-Company Trainer
Signed ………………………………….....................… (Parent/ Guardian)
Date: ……………………………
(Append approved Immersion Schedule)
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