Republic of the Philippines
CENTRAL PHILIPPINES STATE UNIVERSITY
College of Teacher Education
San Carlos City, Negros Occidental
PARENTS CONSENT
I hereby willingly and voluntarily grant consent to the participation of son/daughter
________________________________________
________________________
(NAME)
(COURSE & YEAR)
Enrolled at Central Philippines State University DJVV Campus to have his/her Practice
Teaching at _______________________________________
(NAME OF SCHOOL)
From November 7, 2016
___________________
(ADDRESS)
to January 13, 2017.
(Date)
(Date)
I have considered the benefits and learning that will be obtained by my son/daughter from
this exposure with the understanding that due care and precautions will be observed to ensure the
safety of the students. I voluntarily waive any claim against the school and/or authorities-incharge, for any untoward incidents which may occur after all precautionary measures and
exhaustive effort have been taken by the persons in-charge.
_________
__________________________________
Signature over Printed Name of Parent/Guardian
___________________________
Date Accomplished
(For the Students)
I agree to follow all instructions and procedures during the activities and also to maintain a
maximum level of safety.
___________________________________________
Students Signature over Printed Name
___________________________
Date Accomplished
SUBSCRIBED AND SWORN before me this _________day of ____________________, 2016
by ______________________who exhibited to me her/his CTC No. _______________ issued
on ____________________ at __________________________.
WITNESS MY HAND AND SEAL.
Doc. No. _________________
Page No. _________________
Book No. _________________
Series of __________________