Republic of the Philippines Department of Education Division of Lapu-Lapu City SCIENCE and TECHNOLOGY EDUCATION CENTER SCIENCE and

TECHNOLOGY HIGH SCHOOL Basak, Lapu-Lapu City http://smart.com.ph/smartschools/stec (032)495-9505 CERTIFICATE OF PARENTAL CONSENT We, _________________________________________ who are the legal parents/guardians of ________________________________________ of Science and Technology Education Center Science and Technology High School, with residence address at __________________________________ do hereby certify that we give our full consent for her/him to participate in ________________________ on ________________, ___, 20__ with the following conditions: 1. Our child will be chaperone/escorted by a teacher/adviser of the subject/activity. 2. The chaperoned/escorted will look at the safety, behavior and physical upkeep of our child as far as humanly possible. 3. If any untoward incident happens to the student, which is beyond control, the school officials shall not be held liable. 4. Considering the above conditions and the benefits that our child will derived from his/her participation in this activity and realizing that every precaution will be undertaken by the chaperon and your office, we, the undersigned parents or guardians of the above named student give our consent for him/her to participate in the said activity.

Father: ________________________________________
Signature over Printed Name

Mother: ________________________________________
Signature over Printed Name

Date: ___________________________ `

Date: ___________________________