Republic of the Philippines
Department of Education
REGION VIII
SCHOOLS DIVISION OF BORONGAN CITY
PARENTAL CONSENT FORM
I, ______________________________________, as the parent or legal guardian of
___________________________________________, a learner of the
______________________________________________ (school) hereby acknowledge that I have
been informed of the details of the conduct of the face-to-face
__________________________________________________________________________________
(name of activity) that will be held on _________________________________(date) at
________________________________________________________________(venue).
I understand that my child’s in-person attendance in the event will include associating with teachers,
fellow learners and school personnel, and other persons inside and outside of the school that may put
my child at risk of COVID-19 transmission, notwithstanding the precautions undertaken by the
implementing team.
In consideration of the consent given for the participation in the above-mentioned activity, I, or my
child’s authorized guardian, together with my child, do hereby release and waive DepEd Borongan
City – Youth Formation Program, its officers, faculty, staff, and representatives, from any and all
claims should any damage be caused or liability be incurred to property or person arising from, but
not limited to, participation in the said activity. I expect and know that the school will exercise the
diligence required for the safety and well-being of my child and that his/ her participation in the
activity will be beneficial to him/ her. However, participation in the activity carries with it certain
risks that cannot be eliminated regardless of the care taken to avoid injuries. I know and understand
these and other risks that are inherent to the stated activity and I hereby assert that my child’s
participation, as well as my consent to it, is voluntary and I hereby assert my child’s participation, as
well as my consent to it, is voluntary and that I knowingly assume all such risks.
Documentation
I confirm that I give full permission in any recording or picture taken of my child during the conduct
of this event and to use some or all of my child’s voice recordings, videos, and images in print media,
the official publication and social media page (including electronic publications such as film or
website) created by or for the DepEd Schools Division Office of Borongan City and its program
partners and to release this material to the official platforms of the Department.
Confidentiality
I am aware that any information that will be given during the activity will be kept strictly confidential,
and personal information will be treated in accordance with the Data Privacy Act of 2012. I am
assured that the information about my child will not be shared outside of the implementation team.
My child’s name will not be used when data from this activity will be analyzed.
I hereby confirm that I agree and understand the commitment of my child as a participant. I also
understand and will support my child’s endeavor to meet the expectations, guidelines, and
responsibilities to his/her fellow participants and to the Schools Division of Borongan City.
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San Fernando St., Brgy. G, Borongan City
(055) 560-9198
borongancity.region8@deped.gov.ph
Department of Education, Schools Division of Borongan City
To the extent allowed by law and rules, I hereby agree to waive, release, and discharge any and all
claims, causes of action, damages, and rights against the school/division and its personnel as well as
officials relative to the conduct of the activity.
With full understanding, I – on behalf of myself, my household members, and my child/ren – hereby
freely and voluntarily give my consent to my child’s participation in the activity on
_________________________. I also attest that I had sought the views of my child and he/she has
expressed willingness to participate in the activity.
CONTACT DETAILS FOR QUESTIONS OR PROBLEMS
For any concerns or clarification, you may contact the Division Youth Formation Coordinator -
through the email address franklin.pabello@deped.gov.ph (cc:
borongancitydivision.region8@deped.gov.ph).
_____________________________________________ __________________________________________
Signature of Parent/Guardian over Printed Name Contact Details (Mobile Number)
_____________________________________________ __________________________________________
Name of Children Date
* Please submit this form to your child’s school prior to the participation on the event.
(055) 560-9230 | borongancity.region8@deped.gov.ph Page 2 of 2
