Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OFFICE OF AURORA
Office of the Schools Division Superintendent
Enclosure No. 1 to Division Memorandum No. _____, s. 2024
DIVISION LEADERSHIP TRAINING FOR YOUTH EMPOWERMENT 2024
PRE-REGISTRATION FORM
School/District: ______________________________
(Please write legibly and complete all data required)
NO. NAME OF PARTICIPANTS POSITION/ COMPLETE CONTACT NO.
DESIGNATION ADDRESS
Francis Heinrich M. Bernalte SSLG President Obligacion, 09912694901
1. Baler
Sheila May C. Segui SSLG Vice Obligacion, 09851429320
2. President Baler
Princess Jane L. Teh YES – O Obligacion, 09812026973
3. President Baler
Rhon Christof C. Samonte YES – O Vice Obligacion, 09852685346
4. President Baler
Johnsen R. Quibuyen BKD President Obligacion, 09942594884
5. Baler
6. Wendylyn Dob BKD PIO Obligacion, 09924620186
Baler
7. Richard V. Ricardos Adviser Baler, Aurora 09942608452
Date: September 17, 2024 JOUIE C. DE LEON
PhD
School Head
(Supreme Secondary Learner
Government)
_______________________________
__
Address: Sitio Hiwalayan, Brgy. Bacong, San Luis, Aurora
Contact No.: (042) 724-9190
Email Address:
[email protected] Official Website: https://depedaurora.ph
Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OFFICE OF AURORA
District Coordinator
(Supreme Elementary Learner
Government)
Office of the Schools Division Superintendent
Enclosure No. 2 to Division Memorandum No. _____, s. 2024
DIVISION LEADERSHIP TRAINING FOR YOUTH EMPOWERMENT 2024
PARENTAL CONSENT
STUDENT’S PERSONAL INFORMATION:
Name: ____________________________________________________________ Age: _______
Birthday: _________________
Grade Level: ______ School: _________________________________ Organization
Representing: _______________
Address: ___________________________________ Email Address: _________________________
Contact Person in case of emergency: _______________________________________
Relationship: ______________
Contact No. : _________________________
To whom it may concern,
The undersigned hereby give permission to
______________________________________________________
(name of
child)
a Grade ______ student of ____________________________________________ to participate in
the
(level) (name of school)
Division Leadership Training for Youth Empowerment 2024 on September 27-28, 2024
(date)
at Casiguran National High School.
(training venue )
I hereby authorize an adult in the person of the assigned Teacher-Adviser to assist
and accompany my child in participating in the said activity. I have considered the
benefits that my son/daughter will derive from his/her participation in this activity
provided that the due care and precaution will be observed to ensure the comfort and
safety of my son/daughter and that DepEd employees and personnel may not be held
Address: Sitio Hiwalayan, Brgy. Bacong, San Luis, Aurora
Contact No.: (042) 724-9190
Email Address:
[email protected] Official Website: https://depedaurora.ph
Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OFFICE OF AURORA
responsible for any untoward incident that may happen beyond their control.
_________________________________________
_____________________________________
(Signature Over Printed Name)
(Signature Over Printed Name)
Parent/Guardian
Student Participant
_____________________
Date signed
Verified by:
________________________________________
(Signature Over Printed Name)
School Head
Address: Sitio Hiwalayan, Brgy. Bacong, San Luis, Aurora
Contact No.: (042) 724-9190
Email Address:
[email protected] Official Website: https://depedaurora.ph
