P A R E N T A L C O N S E N T: Department of Education

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Republic of the Philippines

DEPARTMENT OF EDUCATION
Cordillera Administrative Region
Division of Apayao
Kabugao District
Kalliat Elementary School

P A R E N T A L C O N S E N T

I/We hereby willingly and voluntarily give consent the participation of


my/our son/daughter __________________________________ in the
_________________________________________ to be held at Payanan Sports
Complex, Luna, Apayao on November __________, 2014.

I/We have considered the benefits that my/our son or daughter will
derive from his/her participation in this activity provided that due care and
precaution will be observed to ensure the comfort and safety of my/our
son/daughter and that DepED employees and personnel may not be held
responsible for any untoward incident that may happen beyond their control.

_____________________________ _____________________________
Signature of Father Signature of Mother

_____________________________ _____________________________
Name of Father Name of Mother

_____________________________________
Signature of Guardian over Printed Name

_____________________________________
(Relationship with the Athlete/Participant)

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