Parental Consent: (Region) (Division) School (School Address)

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Republic of the Philippines

DEPARTMENT OF EDUCATION
REGION VI-WESTERN VISAYAS
(Region)
SCHOOLS DIVISION OF ILOILO
(Division)
ROBERTO H. TIROL HIGH SCHOOL
School
BACJAWAN SUR, CONCEPCION, ILOILO
(School Address)

SEPTEMBER 17, 2018


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 MAY ANN V. PANGANIBAN in the Division, Regional Meet and Palarong
Pambansa.

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 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

TRANQUILINO A. PANGANIBAN MARILOU V. PANGANIBAN


Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :

KAREN MAE T. HERIDA ENGR. ISAGANI M. JALANDONI


Teacher-Adviser School Head

Remarks:

FOR PALARONG PAMBANSA ONLY

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