Republic of the Philippines
Department of Education
REGION XIII, CARAGA
(Region)
SURIGAO DEL SUR
(Division)
ANTONIO A. OROZCO ELEMENTARY SCHOOL
(School)
SITIO TAMSIAN, PAGTILAAN, LINGIG, SURIGAO DEL SUR
(School Address)
PARENTAL CONSENT
Date:
To Whom It May Concern:
I/We hereby willingly and voluntarily give consent to the participation of my/
our son/daughter
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 above-
mentioned athlete in accordance with the Data Privacy Act of 2012.
Signature of Father Over Printed Name Signature of Mother Over Printed Name
Verified:
Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)
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.
