Enclosures 6 To 10

Republic of the Philippines
Department of Education
Region V -Bicol
SCHOOLS DIVISION OFFICE OF ALBAY
DM No.___ ,s. 2024

Enclosure 6
PARENTAL CONSENT AND WAIVER/RELEASE FORM
As the parent or guardian of the child named below, I hereby give my full
consent and approval for my child to participate in the 2024 Division Math Fair. I
understand that there are certain risks of injury inherent in the conduct of the
said activity, as well as in traveling and other related activities incidental to my
child’s participation, and I am willing to assume these risks on behalf of my child. I
hereby certify that my child is fully capable of participating in the
__________________________ (name of event) and that my child is healthy and has
no physical or mental disabilities or infirmities that would restrict full participation
in the said event and other activities incidental thereto.
In addition to giving my full consent for my child’s participation, I do hereby

waive, release and hold harmless the Department of Education, supervisors and
coordinators, coaches, organizers and members of the Regional Technical
Working Group of and from any and all rights and claims for damage resulting
from injury that may be suffered by my child in the normal course of participation
in _________________________ (name of event) and the activities incidental thereto.
_________________________________________ _____________________ _______

Name of Child Date of Birth Sex
Address:
_________________________________________________________________________
_________________________________________________________________________
Please list any physical limitations (allergies, hearing, sight, etc.)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
I certify that I have read the Parental Consent and Waiver/Release Form and fully
understand its terms and conditions.
_______________________________________ ______________
__________________
Signature over Printed Name of Parent/Guardian Date CP Number
Lignon Hill, Bogtong, Legazpi City

Telephone No. (052)7425380 / (052)7425381
[email protected] depedtayosdoalbay
www.depedalbay.com
Region V -Bicol
DM No.___ ,s. 2024

Enclosure 7
STUDENT MEDIA RELEASE CONSENT FORM
I, the undersigned, hereby grant the Department of Education –2024

Division Math Fair the right to record, film, photograph, audiotape or videotape of
me, my work, and performances.
I also grant to the right to edit, use, and reuse said products for nonprofit
purposes including use in print, on the internet, and all other forms of media.
I also hereby release the Department of Education and its agents and
employees from all claims, demands, and liabilities whatsoever in connection with
the above.
I certify that I have read the Media Consent and Release Form and fully
Agreed and accepted by
Signature of Student: ______________________________ Date: _____________________
Address of Student: _________________________________________________________
Parental Consent:
I certify that I am the parent or guardian of,

______________________________________, a minor under the age of eighteen years. I
hereby agree to assume legal responsibility of his/her authorizations referred to in
this Media Consent and Release.
Signature over Printed Name of Parent/Guardian:

__________________________________
Address: ____________________________________________ Date: _________________
CP Number: _________________________________

Telephone No. (052)7425380 / (052)7425381
www.depedalbay.com
Region V -Bicol
DM No.___ ,s. 2024

Enclosure 8
MEDIA RELEASE CONSENT FORM
I, the undersigned, hereby grant the Department of Education –2024

Division Math Fair the right to record, film, photograph, audiotape or videotape of
me, my work, and performances.
I also grant to the right to edit, use, and reuse said products for nonprofit
purposes including use in print, on the internet, and all other forms of media.
I also hereby release the Department of Education and its agents and
employees from all claims, demands, and liabilities whatsoever in connection with
the above.
I certify that I have read the Media Consent and Release Form and fully
Agreed and accepted by
Signature of Participant: ______________________________ Date: ___________________
Address of Participant: _______________________________________________________
CP Number: ____________________________

Telephone No. (052)7425380 / (052)7425381
www.depedalbay.com
Region V -Bicol
DM No.___ ,s. 2024

Enclosure 9
CERTIFICATE OF ORIGINALITY
This is to certify that this output/material is an outcome of my/our own

independent and creative work. The content and materials used are free from
infringement with proper authorization and attribution. For borrowed materials
substantively used, permission was sought from the copyright owner and/or
author for its use. To the best of my/our knowledge and belief, it contains no
material previously published.
Name of Author(s) and Signature:
_________________________________________________ _______________________
_________________________________________________ _______________________
_________________________________________________ _______________________
Kind/nature and title of the output/material (please check):
____ e-Modulo Art Title (if applicable) ___________________________________
____ MATHDokyu/Video Production
Title (if applicable): ___________________________________
_____________________________________________
_____________________________________________
____ Math Showcase
____ Device ____ Puzzle ____ Games
Title (if applicable): ___________________________________
_____________________________________________
_____________________________________________
DM No.___ ,s. 2024

Telephone No. (052)7425380 / (052)7425381
www.depedalbay.com
Region V -Bicol
Enclosure 10
CERTIFICATION
KNOW ALL MEN BY THESE PRESENTS:
That I/We _________________________________________________________________

__________________________________________________________________________________
_______________________________________________________________________________ of
________________________________________________________________________ author (s)
in the ____________________________________________________________________ hereby
certify that my/our entry is my/our own and is new and original to the best of our
knowledge.
I/We certify that we give permission for Division Math Fair to share the said
output/material as
supplemental materials to be used in the classrooms.
In WITNESS WHEREOF, I/We have hereunto set our hands on this ________
day of _________________, 2024 at _________________________________________.
______________________________ ______________________________
Witness Witness
SUBSCRIBED AND SWORN TO before me this ________ day of ________ 2024, at

______________________, Philippines, affiant ___________________________, exhibiting
his proof of identity as stated above.
Doc. No.: _____________
Page No.:_____________
Book No.:_____________
Series of 2024

Telephone No. (052)7425380 / (052)7425381
www.depedalbay.com

Enclosures 6 To 10

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Republic of the Philippines

DM No.___ ,s. 2024

PARENTAL CONSENT AND WAIVER/RELEASE FORM

In addition to giving my full consent for my child’s participation, I do hereby

_________________________________________ _____________________ _______

Please list any physical limitations (allergies, hearing, sight, etc.)

Lignon Hill, Bogtong, Legazpi City

DM No.___ ,s. 2024

STUDENT MEDIA RELEASE CONSENT FORM

I, the undersigned, hereby grant the Department of Education –2024

Agreed and accepted by

Signature of Student: ______________________________ Date: _____________________

Address of Student: _________________________________________________________

I certify that I am the parent or guardian of,

Signature over Printed Name of Parent/Guardian:

Address: ____________________________________________ Date: _________________

Lignon Hill, Bogtong, Legazpi City

DM No.___ ,s. 2024

MEDIA RELEASE CONSENT FORM

I, the undersigned, hereby grant the Department of Education –2024

Agreed and accepted by

Signature of Participant: ______________________________ Date: ___________________

Address of Participant: _______________________________________________________

Lignon Hill, Bogtong, Legazpi City

DM No.___ ,s. 2024

This is to certify that this output/material is an outcome of my/our own

Name of Author(s) and Signature:

Kind/nature and title of the output/material (please check):

____ e-Modulo Art Title (if applicable) ___________________________________

____ MATHDokyu/Video Production

Title (if applicable): ___________________________________

____ Device ____ Puzzle ____ Games

Title (if applicable): ___________________________________

DM No.___ ,s. 2024

Lignon Hill, Bogtong, Legazpi City

KNOW ALL MEN BY THESE PRESENTS:

That I/We _________________________________________________________________

supplemental materials to be used in the classrooms.

SUBSCRIBED AND SWORN TO before me this ________ day of ________ 2024, at

Doc. No.: _____________

Lignon Hill, Bogtong, Legazpi City

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___________________________ _ _

Signature of Student: __________ Date: _

Address: ____________________________ Date: _

Signature of Participant: ____________ Date: _

e-Modulo Art Title (if applicable) _______________________________

Device Puzzle Games

SUBSCRIBED AND SWORN TO before me this day of 2024, at