Republic of the Philippines

Department of Education
Schools Division of Las Piñas City
Las Piñas City National Science High School
Carnival Park St. BF Resort Village, Talon II, Las Piñas City

MEDICAL CONSENT

I/We, the parent/guardian of ________________________________hereby, give my

permission in full consciousness so the medical staff/personnel/volunteers who are involved
and participating in the National Science and Technology Fair 2020 being carried out on
_____________________ to administer any possible relevant medication and treatment with
the benefit of the named patient when or if necessary.

I/We shall be responsible for informing the organized club regarding the medication
requirements and any known medical condition.

In addition to this, in any case when the condition becomes worse, I/we give authorization to
the members of medical staff/personnel/volunteers to take my daughter/son to the
clinic/hospital and give entire permission to them for carrying out any sort of treatment or
medical procedure which is required to be carried out in accordance with the diagnosis
performed by hospital/clinic.

I/We comprehend I/we shall be notified of the hospital/clinic visit and the medical
treatment provided by the hospital, as early as possible.

I/We have considered the benefits that my/our son/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

Name of Father Name of Mother

Contact No. Contact No.

Signature of Guardian over Printed name

(Relationship with the Participant)

Contact No.

8817-2068 | 8880-0045
lpscience09@gmail.com | lpshssenior@gmail.com