Republic of the Philippines
Department of Education
National Capital Region
Schools Division Office of Caloocan City
CALOOCAN CITY SCIENCE HIGH SCHOOL
P. Sevilla Street. cor. 10th Avenue, West Grace Park Caloocan City, 1400
PARENT’S / GUARDIAN’S CONSENT FORM
Name of Learner: _________________________________________________________
Date of Birth:______________________________ Sex: ______________________
Parent’s / Guardian’s Name: ______________________________________________
Relationship to Learner:
___________________________________________________
Home Address: ___________________________________________________________
Contact Number: _________________________________________________________
Title of the Activity: Training for PMO Qualifying Round
Venue: CCSHS Campus
Date of Activity: November 19-22, 2024 ( 3:00 – 5:00 PM)
_________ I hereby consent to allow my child or children to
participate
in the in/off-campus activity
_________ I am not allowing my child / children to participate in the
in/off-campus activity.
As parent / guardian of the abovementioned learner, I hereby
acknowledge that I have been informed of the details of the in/off-campus
activity and voluntarily and freely elect to participate in this in/off-campus
activity. Furthermore, I understand the risks associated with an in/off
campus activity and agree that the rules and regulations established for
the said activity are for the safety and security of the participants, and
thus agree to instruct my child or children to obey them, should I allow my
child to participate.
____________________________________
Signature over Printed name of
Parent / Guardian
P. Sevilla St. corner 10th Avenue, West Grace
Park, [Link]@gmail.c
Caloocan City, 1400
Telephone No : (02) 8875-5472 [Link]/ccshs
