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Consent-Form-2024

The document is a consent form for a student's participation in a Work Immersion program as part of the Senior High School Curriculum. It requires details about the student, their medical background, and an undertaking by the parent/guardian confirming their agreement and understanding of the program. The form must be signed by the parent or guardian to validate the consent.

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Earl Kevin Fabela
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9 views

Consent-Form-2024

The document is a consent form for a student's participation in a Work Immersion program as part of the Senior High School Curriculum. It requires details about the student, their medical background, and an undertaking by the parent/guardian confirming their agreement and understanding of the program. The form must be signed by the parent or guardian to validate the consent.

Uploaded by

Earl Kevin Fabela
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Consent Form

Name of Student : __________________________________________________

Date of Birth : __________________________________________________

School : __________________________________________________

Name of Parent/Guardian : ______________________________________

Address : __________________________________________________

Contact Number : __________________________________________________

MEDICAL BACKGROUND
Does your child suffer from any medical conditions/allergies?
(please check appropriate box)
□Yes □ No
Please provide details of medication that must be administered, if any:
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________

UNDERTAKING:

a) I agree to my son/daughter taking part in the Work Immersion as a key feature of the

Senior High School Curriculum, which involves hands-on experience or work simulation

in which learners can apply their competencies and acquired knowledge relevant to

their track;

b) I confirm to the best of my knowledge that my son/daughter does not suffer from any

medical condition other than those listed above;

c) That I have read and fully understood the statements above including the implications

thereof.

_____________________________________________
Signature Over Printed Name of Parent/Guardian

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