Revised as of September 26,
2019
Republic of the Philippines
DEPARTMENT OF EDUCATION
________________________
(Region)
______________________________
(Division)
______________________________
(School)
______________________________
(School Address)
_____________________
Date
PARENTAL CONSENT
I/We hereby willingly and voluntarily give consent to the participation of
my/our son/daughter
Eric Jun N. Ua-o
in _______________ in
all School Sports Meets up to the Palarong Pambansa.
I/We have considered the benefits that my son or daughter will derive
from his/her participation in this activity provided that due care, diligence and
necessary precautions will be observed to ensure his/her health and safety.
Further, I/We authorize the personnel of Department of Education to
collect, process, retain, and dispose of personal information of the abovementioned athlete in accordance with the Data Privacy Act of 2012.
NEVOH S. UA-O
Signature of Father Over Printed Name
PACITA N. UA-O
Signature of Mother Over Printed Name
Verified:
CHRISTINE MARIE EMNACE
Adviser
MARY GRACE C. MESIAS
(Signature Over Printed Name)
(Signature Over Printed Name)
School Head/Registrar
Remarks:
Note:
Submit the necessary documents, i.e. Affidavit/Sworn Statement of Actual Care and Custody
duly verified by the adviser and school head, in cases signature of parents are unavailable.
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)