Republic of the Philippines
Department of Education
REGION IV- A CALABARZON
SCHOOLS DIVISION OF IMUS CITY
BAYAN LUMA II ELEMENTARY SCHOOL
BAYAN LUMA VIII IMUS CITY
Annex 2. Parent / Legal Guardian Consent Form
IV - A
Region
Imus City
Division
Bayan Luma II Elementary School
School
Bayan Luma VIII, Imus City, Cavite
School Address
_____________
Date
PARENTAL CONSENT
I / We hereby willingly and voluntarily give consent to the participation of my / our
son / daughter _______________________________________________________in the National Learning Camp
from July 2 to 4 , 9 to 11, and 16 to 18.
I have considered the benefits that my son / daughter will get from his / her participation in this activity
provided that 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 responsible for any untoward incident that may happen beyond their
control.
___________________________ ____________________________
Signature of Father Signature of Mother
over printed Name/ Date over printed Name/ Date
______________________________
Signature of Guardian
over printed Name/ Date
______________________________
Relationship with the Learner
Verified By:
___________________________________________________ Date: _______________
Teacher
Note: If No Parent / s, submit an affidavit of Guardianship duly verified by the teacher
Address: Bayan Luma VIII Imus City
Telephone Number: 471-0767
Email Address: bayanluma2@[Link]/107971@[Link]
Website: [Link]
Facebook Page: DepEd Tayo Bayan Luma II ES – Imus City