TFSS Form No.

004 PC

Republic of the Philippines

Department of Education
______________________
(Region)
______________________________
(Division)

P A R E N TA L C O N S E N T

I/We hereby willingly and voluntarily give consent to the participation of my

son/daughter _____________________________________ in the Lower meets up to
Palarong Pambansa to be held at _________________________ on _______________

I have considered the benefits that my son/daughter will derive from his/her
participation in this activity with the understanding that due care and precaution will be
observed to ensure the comfort and safety of the delegation 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

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with Athlete)

Verified by:

Teacher-Adviser Principal/School Head

Any mark or alteration of any entry invalidates the document