Republic of the Philippines
Department of Education
                                      REGION III – CENTRAL LUZON
                                SCHOOLS DIVISION OF CITY OF MEYCAUAYAN
                                     ZAMORA ELEMENTARY SCHOOL
                                 ZAMORA, CITY OF MEYCAUAYAN, BULACAN
                                                 PARENTAL CONSENT
Name of the Learner: _____________________________________________________________________________
Date of Birth: ______________________________________________                       Sex: _________________________
Parent/Guardian Name: ___________________________________________________________________________
Relationship to the learner: ______________________________                         Contact Number: _______________
Address: _______________________________________________________________________________________
Title of the Activity: Division School Press Conference
Venue: Meycauayan West Central Integrated School          Date: November 3, 2023       Time:8:00mPm
                 As the parent/guardian of the above mentioned name, I hereby acknowledge that I have been
informed of the details of the off-campus activity and voluntarily and freely elect to participate in this off-campus
activity furthermore, I understand the risk associated the off-campus activity and agree that the rules and
regulations established for the said activity are for the safety and security of the participant and thus agree to
instruct my child to obey them.
                  Having understood of the aforementioned, I hereby consent to allow my child to participate,
acknowledging all the foregoing. I am also solely responsible for providing travel insurance and any expense for my
child’s participation in the activity.
Note: (other information you wish to inform the teacher, such as child condition, etc.)
                                                                   ___________________________
                                                                      Signature Over Printed Name
                                                                          PARENT/GUARDIAN
Verified by:
        STELLA MARIS M. DUMALAY                                                              SYLVIE V. LEGARADA
          SPA Adviser-English                                                                SPA Adviser-Filipino
                                                       Noted by:
                                             MA. BENILDA M. MENDOZA
                                                 Teacher-In-Charge
                                    Address: Ricabo St. Zamora, City of Meycauayan Bulacan
                                    City of Meycauayan, Bulacan
                                    Contact No. 09338626587
                                    104938.meyc@deped.gov.ph