Republic of the Philippines
Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF TARLAC PROVINCE
BUENLAG NATIONAL HIGH SCHOOL (300954)
BUENLAG, GERONA, TARLAC
PARENT’S/ GUARDIAN’S CONSENT FORM
Name of Learner: ____________________________________________________________
Date of Birth: ________________ Sex: _____________________
Parent’s/ Guardian’s Name:___________________________________________________
Relationship to the learner:____________________________________________________
Home Address:_______________________________________________________________
Contact numbers: ___________________________________________________________
Title of Activity:________________
Venue:________________ Date of Activity: November 7-8, 2023
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 regulation 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 the aforementioned, I hereby consent to allow my child/children to participate,
acknowledging all of the foregoing. I am also solely responsible for providing travel insurance and any
expenses for my child/children’s participation in the activity.
_____________________________________ ___________________________________________
Parent/Guardian’s Name and Signature Date
Notes: other information you may wish to inform the teacher, such as child’s medical
condition, etc.
