Republic of the Philippines
Department of Education
                                      REGION IV-A CALABARZON
                                                    (Region)
                                                 LIPA CITY
                                                    (Division)
                     SAN CELESTINO INTEGRATED NATIONAL HIGH SCHOOL
                                                    (School)
                                      SAN CELESTINO, LIPA CITY
                                                (School Address)
                                     PARENTAL CONSENT
                                                                         Date: February 21, 2025
To Whom It May Concern:
       I/We hereby willingly and voluntarily give consent to the participation of my/our son/daughter
in Local Tour on February __, 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 the Department of Education to collect, process,
retain, and dispose of personal information of the above-mentioned athlete 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 the signatures of parents are unavailable.