Republic of the Philippines

DEPARTMENT OF EDUCATION
VI ______VI- WESTERN VISAYAS___
(Region)
____________ILOILO___________
(Division)
BALBINO SERON ELEMENTARY SCHOOL
(School)
BUCAYA, SAN JOAQUIN, ILOILO
(School Address)

________________
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 _______________________________________ in the lower meets and
2018 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

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :
LORENA S. SANTIAGUDO
__________________________________________________
Teacher-Adviser/School Head/Registrar

Remarks:
 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI ______VI- WESTERN VISAYAS___
(Region)
____________ILOILO___________
(Division)
BALBINO SERON ELEMENTARY SCHOOL
(School)
BUCAYA, SAN JOAQUIN, ILOILO
(School Address)

August 30, 2017

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 __________EK CELEST SEDANO_________ in the lower meets and
2018 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 Mother

EUSEBIO SEDANO KAREN SEDANO

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :
LORENA S. SANTIAGUDO
__________________________________________________
Teacher-Adviser/School Head/Registrar

Remarks:
 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI ______VI- WESTERN VISAYAS___
(Region)
____________ILOILO___________
(Division)
BALBINO SERON ELEMENTARY SCHOOL
(School)
BUCAYA, SAN JOAQUIN, ILOILO
(School Address)

August 30, 2017

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 __________CATHERINE ROBLES_________ in the lower meets and
2018 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

JUDY ROBLES TEODORA ROBLES

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :
LORENA S. SANTIAGUDO
__________________________________________________
Teacher-Adviser/School Head/Registrar

Remarks:
 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI ______VI- WESTERN VISAYAS___
(Region)
____________ILOILO___________
(Division)
BALBINO SERON ELEMENTARY SCHOOL
(School)
BUCAYA, SAN JOAQUIN, ILOILO
(School Address)

August 30, 2017

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 __________ANTHEA SHANE SERMONIA_________ in the lower
meets and 2018 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

JONATHAN SERMONIA ANA MARIA SERMONIA

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :
LORENA S. SANTIAGUDO
__________________________________________________
Teacher-Adviser/School Head/Registrar

Remarks:
 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI ______VI- WESTERN VISAYAS___
(Region)
____________ILOILO___________
(Division)
BALBINO SERON ELEMENTARY SCHOOL
(School)
BUCAYA, SAN JOAQUIN, ILOILO
(School Address)

August 30, 2017

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 __________MARC IAN S. YOCOGCO_________ in the lower meets
and 2018 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

JUN-JUN YOCOGCO ROSALIE YOCOGCO

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :
LORENA S. SANTIAGUDO
__________________________________________________
Teacher-Adviser/School Head/Registrar

Remarks:
 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI ______VI- WESTERN VISAYAS___
(Region)
____________ILOILO___________
(Division)
BALBINO SERON ELEMENTARY SCHOOL
(School)
BUCAYA, SAN JOAQUIN, ILOILO
(School Address)

August 30, 2017

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 __________DAVID LAWRENCE SEMILLA_________ in the lower
meets and 2018 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

RICO SEMILLA LIESEL SEMILLA

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :
LORENA S. SANTIAGUDO
__________________________________________________
Teacher-Adviser/School Head/Registrar

Remarks:
 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI ______VI- WESTERN VISAYAS___
(Region)
____________ILOILO___________
(Division)
BALBINO SERON ELEMENTARY SCHOOL
(School)
BUCAYA, SAN JOAQUIN, ILOILO
(School Address)

August 30, 2017

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 __________JUSTINE SARABIA in the lower meets and 2017
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

ANTONIO SARABIA JOYLN SARABIA

Name of Father Name of Mother

Signature of Guardian over Printed name

(Relationship with the Athlete)

Verified by :
LORENA S. SANTIAGUDO
__________________________________________________
Teacher-Adviser/School Head/Registrar

Remarks:
 Republic of the Philippines
DEPARTMENT OF EDUCATION
VI ______VI- WESTERN VISAYAS___
(Region)
____________ILOILO___________
(Division)
BALBINO SERON ELEMENTARY SCHOOL
(School)
BUCAYA, SAN JOAQUIN, ILOILO
(School Address)

August 30, 2017

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 _____DWYNTH KRYZVYLL SELIBIO_____ in the lower meets and
2018 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

Name of Father Name of Mother

ELSIE PACUNLA
Signature of Guardian over Printed name

GRANDDAUGHTER
(Relationship with the Athlete)

Verified by :
LORENA S. SANTIAGUDO
__________________________________________________
Teacher-Adviser/School Head/Registrar

Remarks: