August 28, 2019

Dr. Perlita P. Depatillo

Officer-in-Charge, Public School District Supervisor
Quezon City Science High School

Greetings of Solidarity!

We are Grade 12 students who are currently conducting experimentation as a part of the
requirements in General Chemistry II. In connection to this, we would like to be excused from
our classes on August 28, 2019, from 10AM to 2PM for the exposure to the following
laboratory instruments in Chemistry: (1) Rotary-evaporator; (2) FTIR; (3) Mass Spectrometer;
(4) UV-Vis; (5) Thermal Analysis; and (6) GCMS (if possible) at De La Salle University Manila.
We are also requesting for make-up activities (i.e. written works and performance tasks) that we
will miss on that day.

Thank you very much for your continued support and understanding.

Respectfully yours,

Group-1 Students from 12-Galileo,

CO, Alexis Ivan INOCENCIO, Andre OMELAN, John Paolo

DAMPIL, Deejay Sean LACHICA, Dana Isabelle NOVENO, Mikaela

Noted:

Mr. Richard R. Sagcal

General Chemistry Teacher, MT-1

Approved:

Dr. Perlita V. Depatillo

Officer-in-Charge, Public School District Supervisor
 Parents’ Waiver

As the parent or legal guardian of ___________________,I hereby give my full consent

and approval for my child to participate in the experimentations and laboratory exposure at
________________________________on ___________________.
I understand that there are certain risks of traveling and other related activities incidental
to my child’s participation, and I am willing to assume these risks on behalf of my child. I hereby
certify that my child is fully capable of participating in the laboratory activities and that my child is
healthy and has no physical or mental disabilities or conditions that would restrict full participation
in this activity.
In addition to giving my full consent for my child’s participation, I do hereby waive, release
and hold harmless Quezon City Science High School, its Principal and Teachers for any untoward
incident that may be suffered by my child in the normal course of participation in laboratory
activities incidental thereto, whether the result of negligence or any other cause.

Parent/Guardian: _____________________________ Date: ________________

Signature over Printed Name
Contact number: ____________________________

Parents’ Waiver

As the parent or legal guardian of ___________________ I hereby give my full consent

and approval for my child to participate in the experimentations and laboratory exposure at
________________________________on ___________________.
I understand that there are certain risks of traveling and other related activities incidental
to my child’s participation, and I am willing to assume these risks on behalf of my child. I hereby
certify that my child is fully capable of participating in the laboratory activities and that my child is
healthy and has no physical or mental disabilities or conditions that would restrict full participation
in this activity.
In addition to giving my full consent for my child’s participation, I do hereby waive, release
and hold harmless Quezon City Science High School, its Principal and Teachers for any untoward
incident that may be suffered by my child in the normal course of participation in laboratory
activities incidental thereto, whether the result of negligence or any other cause.

Parent/Guardian: _____________________________ Date: ________________

Signature over Printed Name

Contact number: ____________________________