Republic of the Philippines
Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
SAN GUILLERMO DISTRICT
103692 SAN MARIANO SUR ELEMENTARY SCHOOL
San Mariano Sur, San Guillermo, Isabela
__________________________________________________________________________________
PARENT/GUARDIAN CONSENT FORM
I, _______________________________ confirm that I am the parent/guardian of
_____________________________.
I confirm that the program has been discussed thoroughly, and has been fully
understood by me, and I understand further that the pilot testing of the face to face
classes involves varied activities to be undertaken during the duration of the program,
which requires the active participation of my child.
After an in-depth consideration of both the risks and the benefits of the program, I do
hereby give my full consent for my child/ward to participate in the pilot testing of the
face to face classes.
I have provided my contact details and will proactively inform the program officers
of any changes to the information below.
_______________________________ / ___________________
(Signature over printed name)
(relationship to the learner)
Mobile Number :
___________________________
Address
___________________________
: