Department of Education

Region I
Division of Ilocos Sur
NARVACAN NATIONAL CENTRAL HIGH SCHOOL
SENIOR HIGH SCHOOL
NARVACAN, ILOCOS SUR
PARENT/GUARDIAN/CONSENT FORM
Instruction: Please complete the following, sign and return to:
________________________________ADVISER

Name of Student: ____________________________ Mobile:

Name of Parent/Guardian:
Address:
Mobile:

Does your child suffer from any medical conditions/allergies that the company/teacher should be aware of
(Including any current medication)?

Please provide details of medication that must be administered:

CONSENT (Please read carefully)

a) I agree to my son/daughter taking part in the Work Immersion to develop in him/her the competencies,
work ethic, and values relevant to pursuing further education and/or joining the world of work.
b) I am aware that he/she will be deployed at ________________________________________ and
has to complete a total of 80 hours which will start on ____________________________ and will end
on ______________________, from Mondays to Fridays and Saturdays if necessary at 7:30 am – 4:30
pm.
c) I fully support this undertaking of my son/daughter minimal financial cost (public/private transport/
and meals) and through my attendance/presence if so desired.
d) I confirmed to the best of my knowledge that my/son/daughter does not suffer from my medical
condition other than those listed above.
e) I am aware that the Work Immersion Teacher and TVL Teacher – in - charge will take all necessary
precautions to keep the students safe. However, if despite all the efforts taken, untoward Incidents
beyond their control occur, we will not hold the Work Immersion Partners as well as the school liable.

Signed Date:
(Parent/Guardian)