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    Src-qms-fr-31 Parents-guardians Consent Form 1

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    mikeyrealo20

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    © All Rights Reserved
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    Src-qms-fr-31 Parents-guardians Consent Form 1

    Uploaded by

    mikeyrealo20
    3 views1 page

    Copyright

    © © All Rights Reserved

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    Src-qms-fr-31 Parents-guardians Consent Form 1

    Uploaded by

    mikeyrealo20

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    © All Rights Reserved
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    Enclosure 1

    Department of Education Document Reference Code:


    Region IVA CALABARZON
    SCHOOLS DIVISION OF SANTA ROSA CITY SRC- QMS-FR-31

    Quality Management System Effectivity Date: September 12, 2024

    PARENT’S/GUARDIAN’S Revision No.: 1

    CONSENT FORM Page No.: 1 of 1

    Name of Learner: Michael Angelo C. Realo


    School: Pulong Sta. Cruz National High School
    Date of Birth: April 20, 2009
    Sex: Male
    Parent’s/Guardian’s Name: Melany C. Realo
    Relationship to the Learner: Child
    Home Address: Blk 9 Lot 6 Pontiac St. Mercado Village Pulong Santa Cruz
    Contact Number/s: 09971159249
    Title of the Activity: KABATIRAN 2024: “Droga’y Matuldukan sa Barkadang may
    Kaalaman”
    Venue: Our Lady of Fatima University, Laguna Campus – School Auditorium
    Date of Activity: December 13, 2024

    As the parent/guardian of the abovementioned learner, I hereby


    acknowledge that I have been informed of the details of the activity and freely
    elect to participate 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. I will also remind my child to
    follow the proper health and safety protocols set forth by the IATF, DOH, and
    DepEd in case of his/her participation in a face-to-face activity.

    I hereby allow the organizers to have the photos, videos and/or any
    testimonials of my child as part of the documentation of the said activity.

    I further certify that I am informed of the purpose of the activity and


    willingly and expressly give my consent thereto and that the same shall be
    processed in accordance with the Data Privacy Act of 2012 (Republic Act 10173)
    and the Child Protection Policy of the Department.

    Having understood all the, I hereby consent my child or children to


    participate, acknowledging all of the foregoing.

    _________Melany C. Realo________ __December 6,


    2024__
    Signature over Printed Name Date

    Notes (other information you may wish to inform the teacher, such as medical
    condition, etc.)

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