Parents’ Consent Form
A parent’s consent form is a document signed by parents or legal guardians that grants
permission for a student to undergo Work Immersion.
Consent Form
WORK IMMERSION
Name of School
Date of Birth
School
Name of Parent/Guardian
Address
Contact Number
MEDICAL BACKGROUND
Does your child suffer from any medical conditions/allergies?
(please check appropriate box) □ Yes □ No
Please provide details of medication that must be administered, if any:
UNDERTAKING:
a) I agree to 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.
_____________________________________________ Date: _______________________________________________
Signature Over Printed Name of
Parent/Guardian