Odiong, Roxas, Oriental Mindoro
Tel: (043) 289-7056 / clarchsdept@gmail.com
Work Immersion Form 1
STUDENT INFORMATION SHEET
Name: 2x2 Recent
ID picture
Address:
E-mail Address:
Cellphone No.: Religion:
Date of Birth: Place of Birth:
Father’s Name: Father’s Occupation:
Mother’s Name: Mother’s Occupation:
Health Issues/Allergies:
Hobbies / Past Time Activities:
Skills/Talents:
Extra-curricular Activities in School:
Support group / home companions:
List your favorites:
One word or object that describes yourself:
How do you feel about school?
What are your most memorable subjects / class? Why?
What are your plans after Senior High School?
What is your career path?
What is your philosophy in life?
Do you have plans to go abroad? If yes, where and why?
What are your dreams and ambitions?
How do you plan to achieve your ambitions and goals in life?
What are your expectations and apprehensions for work immersion?
Odiong, Roxas, Oriental Mindoro
Tel: (043) 289-7056 / clarchsdept@gmail.com
PARENT’S CONSENT FORM
Name of Student:
Year and Section:
Contact Number:
Name of Parent/Guardian:
Address:
Contact Number:
MEDICAL BACKGROUND
Does your child suffer from any medical conditions/allergies? (please check the appropriate
box)
□ Yes □ No
Please provide details of medication that must be administered, if any:
UNDERTAKING:
a) I agree with my son/daughter taking part in the Work Immersion as a key feature of the
Senior High School Curriculum, which involves hands-on experience or work
simulation in which learners can apply their competencies and acquired knowledge
relevant to their track;
b) I understand that an insurance for learners in DepEd schools shall be procured by their
respective schools, hence, I hereby release the school, its teachers and personnel from
any and all liability, claims, demands, and causes of action whatsoever arising out of or
related to any loss, damage or injury that may be sustained by my son/daughter during
the Work Immersion;
c) I confirm to the best of my knowledge that my son/daughter does not suffer from any
medical condition other than those listed above;
d) That I have read and fully understood the statements above including the implications
thereof.
____________________________________
Signature Over Printed Name of Parent/Guardian Date: ___________________________
