Republic of the Philippines

REGION IV-A CALABARZON

Division of Rizal
District of San Mateo I
GUITNANGBAYAN ELEMENTARY SCHOOL

ANNEX C: PARENT'S/GUARDIAN'S CONSENT FORM

Name of Learner: _________________________________

Date of Birth: ____________________________ Sex: _____________________
Parent's/Guardian's Name: ____________________
Relationship to Learner: _______________________
Home Address:____________________________________________________________________________
Contact Number/s: ______________________
Title of the Activity: 2018 OFF- CAMPUS ACTIVITY EDUCATIONAL TOUR
Venue: Ocean Adventure, San Guillermo Church,SBMA Tour,Subic Duty Free Date of Activity: January 27, 2019

As the parent/ guardian of the abovementioned learner, I hereby acknowledge that I have been informed
the details of the off-campus activity and voluntarily and freely elect to participate in this off-campus
activity.Furthermore, I understand thye risks associated with an off-campus activity 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.
Having understood all the aforementioned, I hereby consent to allow my child or children to participate,
acknowledging all of the foregoing. I am also solely responsible for providing travel insurance and any expenses
my child or children's participation in the activity.

_____________ _____ ________________

Parent/ Guardian's Name and Signature Date

Republic of the Philippines

REGION IV-A CALABARZON
Division of Rizal
District of San Mateo I
GUITNANGBAYAN ELEMENTARY SCHOOL

ANNEX C: PARENT'S/GUARDIAN'S CONSENT FORM

Name of Learner: _________________________________

Date of Birth: ____________________________ Sex: _____________________
Parent's/Guardian's Name: ____________________
Relationship to Learner: _______________________
Home Address:____________________________________________________________________________
Contact Number/s: ______________________
Title of the Activity: 2018 OFF- CAMPUS ACTIVITY EDUCATIONAL TOUR
Venue: Ocean Adventure, San Guillermo Church,SBMA Tour,Subic Duty Free Date of Activity: January 27, 2019
 As the parent/ guardian of the abovementioned learner, I hereby acknowledge that I have been informed
the details of the off-campus activity and voluntarily and freely elect to participate in this off-campus
activity.Furthermore, I understand thye risks associated with an off-campus activity 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.
Having understood all the aforementioned, I hereby consent to allow my child or children to participate,
acknowledging all of the foregoing. I am also solely responsible for providing travel insurance and any expenses fo
my child or children's participation in the activity.

________________ _____ ________________

Parent/ Guardian's Name and Signature Date
27, 2019

en informed of

e rules and
s agree to

articipate,
y expenses for

27, 2019
n informed of

rules and
agree to

ticipate,
expenses for