LIVING STONES CHRISTIAN ACADEMY
118 Dina St., Rose Park, Concepcion, Tarlac
August 10, 2022
PARENTAL CONSENT
I hereby willingly and voluntarily give consent the Learning Delivery Modality of Face to Face classes of my
child, ____________________________________________ starting August 11, 2022 to October 31, 2022.
I have considered DO NO. 17s.2022 Revised Guidelines on Limited Face to Face classes of my child will derive
his/her LDM, provided that due case and precaution will be observed to ensure the comfort and safety of my child and the
LSCA personnel may not be held responsible for any outward incident that may happen beyond their control.
_______________________________ ___________________________
(Parent) (Guardian)
Signature over Printed name Signature over Printed name
_______________________________
(Adviser)
Signature over Printed name
Noted by: MARILOU M. PINEDA
School Principal
LIVING STONES CHRISTIAN ACADEMY
118 Dina St., Rose Park, Concepcion, Tarlac
August 10, 2022
PARENTAL CONSENT
I hereby willingly and voluntarily give consent the Learning Delivery Modality of Face to Face classes of my
child, ____________________________________________ starting August 11, 2022 to October 31, 2022.
I have considered DO NO. 17s.2022 Revised Guidelines on Limited Face to Face classes of my child will derive
his/her LDM, provided that due case and precaution will be observed to ensure the comfort and safety of my child and the
LSCA personnel may not be held responsible for any outward incident that may happen beyond their control.
_______________________________ ___________________________
(Parent) (Guardian)
Signature over Printed name Signature over Printed name
_______________________________
(Adviser)
Signature over Printed name
Noted by: MARILOU M. PINEDA
School Principal
