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PARENTS Consent IMMERSION - Revised

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19 views

PARENTS Consent IMMERSION - Revised

Uploaded by

alexikiehl2
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Education
Region X – Northern Mindanao
DIVISION OF CAGAYAN DE ORO
Father William Masterson Ave.,
Upper Balulang, Cagayan de Oro City
______________________________________________________________________________________________________

Per DepEd Order 30 s. 2017 Section 5 no. 1:

Work Immersion Requires Parental Consent

PARENTS’ CONSENT FOR SENIOR HIGH SCHOOL WORK IMMERSION

Instruction: Please complete the following with signature then return to the Immersion Teacher

Name of Student: _____________________________________________________ Age: __________


Strand: ________________________________________________________ Grade: ________
Name of Parent/Guardian: ______________________________________________________________
Address:______________________________________________________________________________
Student’s Mobile Number: _________________________Parent’s Mobile Number: ___________________

PARENTAL CONSENT

I,______________________________________________ the undersigned certify that I am the legal parent/ guardian


of_______________________________________________(Name of student/ child) a grade 12 _____________________(Strand)
student.
.I / We hereby willingly and voluntarily give consent to my/our son daughter for his/her work immersion
at__________________________________________________________( Immersion Venue and address)
on ____________________________________________________________________( Immersion dates)
from ________________to_____________( immersion official time).

It is enjoined that the students are expected to follow the terms and conditions stipulated in
DO 30, S 2017 , specifically in the work immersion MOA. I also understand that my son/ daughter is expected to follow the
instructions and precautionary measures given by the Immersion teacher.

In consonance thereof, any untoward incidents run contrary to the objectives of the activity, acts committed that violate the norms
and proper conducts, the Dep. Ed. employees has no liabilities to that effect and that , the school has no administrative, civil and
criminal liabilities.

Furthermore ,

a) I agree to my son/daughter Work Immersion in partial fulfilment of his/her Senior High School requirement.
b) I confirm to the best of my knowledge that my son/daughter does not suffer from any medical condition other
than those listed above.
c) I fully support the work immersion undertaking of my son/daughter.
d) I consent to my son/ daughter travelling by any form of public transport..
e) I understand that the teacher/school accept no responsibility for any untoward incident, damage or injury caused
by or during work immersion based on the attached schedules of the work immersion.
Signed:

_____________________________________
PARENT’S / GUARDIAN SIGNATURE OVER PRINTED NAME
Date:______________________________

Student’s Health Information

Does your child suffer from any medical conditions/allergies that the teacher should be aware of including any current
medication? Please indicate on the space provided:
_____________________________________________________________________
Please provide details of medication that is usually administered to your son/ daughter: ______________________________.

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