Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VIII
(Region)
NORTHERN SAMAR
(Division)
PALANIT ELEMENTARY SCHOOL
(School)
PALANIT, SAN ISIDRO N. SAMAR
(School Address)
February 03, 2025
Date
PARENTAL CONSENT
I/We hereby willingly and voluntarily give consent to the participation of
my/our son/daughter JHANINE T. MAG-AMPO in NumbeRace in Division
Festival of Talents 2025.
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 participant 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.