Republic of the Philippines
Department of Education
REGION IV-ACALABARZON
SCHOOLS DIVISION OF BATANGAS
BALAYAN SENIOR HIGH SCHOOL
CALOOCAN, BALAYAN, BATANGAS
ANNEX C: PARENTS/ GUARDIAN’S CONSENT FORM
NAME OF LEARNER ___________________________________________________________________
DATE OF BIRTH ____________________________________________SEX _______________________
PARENT’S / GUARDIAN’S NAME:_________________________________________________________
RELATIONSHIP TO LEARNER :____________________________________________________________
HOME ADDRESS:______________________________________________________________________
CONTACT
NUMBER/S:__________________________________________________________________
PARENT’S / GUARDIAN’S NAME:_________________________________________________________
TITLE OF THE ACTIVITY :________________________________________________________________
VENUE : _______________________________________DATE OF ACTIVITY:______________________
As the parent/ guardian of the abovementioned learner, 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 risks associated with an off-campus activity
and agree that the rules and regulations established for the said activity are for the safety and security
of the participants, and thus agree to instruct my child or children to obey them.
Having understood all aforementioned, I hereby consent to allow my child or children to
participate, acknowledginf all of the foregoing. I am also solely responsible for providing travel
insurance and any expenses for my child or children’s participation in the activity.
__________________________________________ ________________________________
Parent/Guardian’s Name and Signature Date
Balayan Senior High School (Formerly SHS Within Caloocan ES)
Address: Caloocan, Balayan, Batangas
Email address: 342209@deped.gov.ph
