Republic of the Philippines
Department of Education
Region XI – Davao Region
Schools Division of Davao City
MAHAYAG NATIONAL HIGH SCHOOL
Purok 1 Barangay Mahayag, Davao City
Office of the School Head
PARENT’S CONSENT
Student’s/ Participant’s Name: _________________________________________________________
Date of Birth: _______________________________________________________________________
Parent’s/Guardian’s Name: ____________________________________________________________
Home Address: __________________________________________________________________________
Contact Number: ____________________________________________________________________
Title of Activity: _____________________________________________________________________
Venue of Activity: ____________________________________________________________________
Teacher’s In Charge: __________________________________________________________________
(from School to Venue)
Estimated time and Date of Departure: ___________________________________________________
Estimated time and Date of Arrival: ______________________________________________________
( from venue to residence)
Estimated Time and Date of Departure: _____________________________________________________
Estimated Time and Date of Arrival: ________________________________________________________
I/We ________________________________________________ the parent/s
of__________________________________, HEREBY GRANT PERMSSION for our child to have their WORK
IMMERSION at ________________________________________________________. I/We warrant that our
child is in good health. I/We also agree to pay the reasonable cost or amount of expenses in the said activity.
In the event of an emergency, I/We give permission to transport my/our child to a hospital or any medical facility
for a treatment. I/We wish to be advised prior to any further treatment by a doctor or the hospital.
My/Our child id taking at present: (any medication) _______________________________________
Allergies: (including but not limited to food) _____________________________________________
Other Medical Conditions: ___________________________________________________________
Finally, as parent/guardian, I/We agree to all above stated considerations and conditions.
______________________________
Signature of Parent/ Guardian
_____________
Date