Republic of the Philippines
Department of Education
CARAGA REGION XIII
SCHOOLS DIVISION OF SURIGAO DEL NORTE
ALEGRIA STAND ALONE SENIOR HIGH SCHOOL
School ID 340416
Parental Consent Form
I confirm that _____________________________________________________ is the parent/legal
guardian of ROGELIO A. PAAS, JR.
I hereby consent to the above child participating in the implementation of rules and regulations of
the Republic Act 11596 titled “An Act Prohibiting the Practice of Child Marriage and Imposing
Penalties for Violations Thereof” to be held in Mallberry Suites Business Hotel, Cagayan de Oro City
on October 14-17. I have provided contact details below and undertake to inform the SSG Adviser of
the organization of any changes to this information.
I confirm that all details are correct and I am able to give parental consent for my child to participate
in the public consultations for child sector. I confirm that I have read the school’s Child Protection
Policy and undertake to abide by the obligations which it imposes on me as the parent/legal
guardian of the above-named child.
I acknowledge that the school is not responsible for providing adult supervision for my child except
as set out of the school’s Child Protection Policy.
Name of Parent:
Signature:
Contact Details
Name of Child:
Address:
Parent’s Mobile Phone No.:
Emergency Contact No.:
Address: Brgy. Ouano, Alegria, Surigao del Norte
Telephone no.: (086) 8000029
