Republic of the Philippines

Department of Education
IV-A CALABARZON
(Region)
CAVITE
(Division)
CAVITE NATIONAL SCIENCE HIGH SCHOOL
(School)
GARITA B MARAGONDON, CAVITE
(School Address)

8 February 2019
Date

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

I/We hereby willingly and voluntarily give consent the participation of my/our
son/daughter _____________________________ for the preparation and shooting of a film in
the completion of the requirements in 21st Century Literature from this day February 8, until the
end of March.

I have considered the benefits that my son or daughter will derive 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 the school may not be held responsible for any
untoward incident that may happen beyond their control.

[A schedule of dates needed to shoot the film will be attached to this letter with a time
table. The location will also be place with contact numbers of students who would be in charge
of the film. Safety and precaution will be assured during the activity.]

Signature of Father Signature of Mother

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with Student)

Verified by :

FERRY ANGELYNE SISRACON

Teacher III