ATOK NATIONAL HIGH SCHOOL

Poblacion, Atok, Benguet

SENIOR HIGH SCHOOL

Work Immersion Program

PARENTAL CONSENT FORM

Track and Strand/
Name of Student
Specialization

Contact Number Date of Birth

Board and
Home Address
Lodging Address

Work Immersion
site

Duration of Work
Immersion

MEDICAL BACKGROUND
Does your child suffer from any medical conditions/allergies?

Please provide details of the medication that must be administered, if any:

Undertakings:
a) I agree to my son/daughter taking part in the Work Immersion as a key feature of the Senior High
School Curriculum which involves actual work experience or work simulation in the application of
Information, Communication and Technology (ICT) and where he/she can enhance acquired
knowledge and competencies relevant to her/his track;
b) I confirm to the best of my knowledge that my son/daughter does not suffer from any medical
condition other than those listed above;
c) I fully support this Work Immersion of my son/daughter through sufficient financial cost and through
my attendance/presence if so desired;
d) I have considered the benefits that my son/daughter will derive from this Work Immersion 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;
e) That I have read and fully understood the statements above including the implications thereof.

Name of Father Contact

and Signature Number

Name of Mother Contact

and Signature Number

Verified by:

CHARLIE G. MANANGWE GINA LYNN O. COCOY MERCEDES S. ANTONIO

Work Immersion Teacher Head Teacher III School Principal III

For Work Immersion Program only

 ATOK NATIONAL HIGH SCHOOL
Poblacion, Atok, Benguet

SENIOR HIGH SCHOOL

Work Immersion Program

PARENTAL CONSENT FORM

Track and Strand/
Name of Student
Specialization

Contact Number Date of Birth

Board and
Home Address
Lodging Address

Work Immersion
site

Duration of Work
Immersion

MEDICAL BACKGROUND
Does your child suffer from any medical conditions/allergies?

Please provide details of the medication that must be administered, if any:

Undertakings:
a) I agree to my son/daughter taking part in the Work Immersion as a key feature of the Senior High
School Curriculum which involves actual work experience or work simulation in the application of
Information, Communication and Technology (ICT) and where he/she can enhance acquired
knowledge and competencies relevant to her/his track;
b) I confirm to the best of my knowledge that my son/daughter does not suffer from any medical
condition other than those listed above;
c) I fully support this Work Immersion of my son/daughter through sufficient financial cost and through
my attendance/presence if so desired;
d) I have considered the benefits that my son/daughter will derive from this Work Immersion 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;
e) That I have read and fully understood the statements above including the implications thereof.

Name of Father Contact

and Signature Number

Name of Mother Contact

and Signature Number

Verified by:

MERIAM T. MACAY GINA LYNN O. COCOY MERCEDES S. ANTONIO

Work Immersion Teacher Head Teacher III School Principal III

For Work Immersion Program only

 ATOK NATIONAL HIGH SCHOOL
Poblacion, Atok, Benguet

SENIOR HIGH SCHOOL

Work Immersion Program

PARENTAL CONSENT FORM

Track and Strand/
Name of Student
Specialization

Contact Number Date of Birth

Board and
Home Address
Lodging Address

Work Immersion
site

Duration of Work
Immersion

MEDICAL BACKGROUND
Does your child suffer from any medical conditions/allergies?

Please provide details of the medication that must be administered, if any:

Undertakings:
a) I agree to my son/daughter taking part in the Work Immersion as a key feature of the Senior High
School Curriculum which involves actual work experience or work simulation in the application of
Information, Communication and Technology (ICT) and where he/she can enhance acquired
knowledge and competencies relevant to her/his track;
b) I confirm to the best of my knowledge that my son/daughter does not suffer from any medical
condition other than those listed above;
c) I fully support this Work Immersion of my son/daughter through sufficient financial cost and through
my attendance/presence if so desired;
d) I have considered the benefits that my son/daughter will derive from this Work Immersion 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;
e) That I have read and fully understood the statements above including the implications thereof.

Name of Father Contact

and Signature Number

Name of Mother Contact

and Signature Number

Verified by:

AILEEN MARIE O. SAN LUIS GINA LYNN O. COCOY MERCEDES S. ANTONIO

Work Immersion Teacher Head Teacher III School Principal III

For Work Immersion Program only

 ATOK NATIONAL HIGH SCHOOL
Poblacion, Atok, Benguet

SENIOR HIGH SCHOOL

Work Immersion Program

PARENTAL CONSENT FORM

Track and Strand/
Name of Student
Specialization

Contact Number Date of Birth

Board and
Home Address
Lodging Address

Work Immersion
site

Duration of Work
Immersion

MEDICAL BACKGROUND
Does your child suffer from any medical conditions/allergies?

Please provide details of the medication that must be administered, if any:

Undertakings:
a) I agree to my son/daughter taking part in the Work Immersion as a key feature of the Senior High
School Curriculum which involves actual work experience or work simulation in the application of
Information, Communication and Technology (ICT) and where he/she can enhance acquired
knowledge and competencies relevant to her/his track;
b) I confirm to the best of my knowledge that my son/daughter does not suffer from any medical
condition other than those listed above;
c) I fully support this Work Immersion of my son/daughter through sufficient financial cost and through
my attendance/presence if so desired;
d) I have considered the benefits that my son/daughter will derive from this Work Immersion 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;
e) That I have read and fully understood the statements above including the implications thereof.

Name of Father Contact

and Signature Number

Name of Mother Contact

and Signature Number

Verified by:

For Work Immersion Program only

 ATOK NATIONAL HIGH SCHOOL
Poblacion, Atok, Benguet

SENIOR HIGH SCHOOL

Work Immersion Program
JONA B. KIWAS GINA LYNN O.
COCOY MERCEDES S. ANTONIO
Work Immersion Teacher Head Teacher III School Principal III

For Work Immersion Program only