Republic of the Philippines
DEPARTMENT OF EDUCATION
VI – WESTERN VISAYAS
(Region)
NEGROS OCCIDENTAL
(Division)
SAN ISIDRO ACADEMY OF MOISES PADILLA, NEG. OCC. INC.
(School)
ROXAS ST., BRGY. 6, MOISES PADILLA, NEG. OCC.
(School Address)
PARENTAL CONSENT
Date: January 3, 2024
To Whom It May Concern:
I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter ZYRA ANGEL B. LOPLOP in SWIMMING GIRLS in all School Sports
Meets up to the Palarong Pambansa.
I/We have considered the benefits that my son or daughter will derive from
his/her participation in this activity provided that due care, diligence and necessary
precautions will be observed to ensure his/her health and safety.
Further, I/We authorize the personnel of Department of Education to collect,
process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.
RICHARD G. LOPLOP JOSEPHINE B. LOPLOP
Signature of Father Over Printed Signature of Mother Over Printed Name
Name
Verified:
LESTER JOHN B. NAVA ARMIE GRACE B. TINGSON
Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)
Remarks:
Note:
Submit the necessary documents, i.e. Affidavit/Sworn Statement of Actual Care and Custody duly verified
by the adviser and school head, in cases signature of parents are unavailable.
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines
DEPARTMENT OF EDUCATION
VI – WESTERN VISAYAS
(Region)
NEGROS OCCIDENTAL
(Division)
SAN ISIDRO ACADEMY OF MOISES PADILLA, NEG. OCC. INC.
(School)
ROXAS ST., BRGY. 6, MOISES PADILLA, NEG. OCC.
(School Address)
PARENTAL CONSENT
Date: January 3, 2024
To Whom It May Concern:
I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter JAY ANN B. LOPLOP in SWIMMING GIRLS in all School Sports Meets
up to the Palarong Pambansa.
I/We have considered the benefits that my son or daughter will derive from
his/her participation in this activity provided that due care, diligence and necessary
precautions will be observed to ensure his/her health and safety.
Further, I/We authorize the personnel of Department of Education to collect,
process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.
RICHARD G. LOPLOP JOSEPHINE B. LOPLOP
Signature of Father Over Printed Signature of Mother Over Printed Name
Name
Verified:
JAYPE I. ESPANILLA ARMIE GRACE B. TINGSON
Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)
Remarks:
Note:
Submit the necessary documents, i.e. Affidavit/Sworn Statement of Actual Care and Custody duly verified
by the adviser and school head, in cases signature of parents are unavailable.
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines
DEPARTMENT OF EDUCATION
VI – WESTERN VISAYAS
(Region)
NEGROS OCCIDENTAL
(Division)
SAN ISIDRO ACADEMY OF MOISES PADILLA, NEG. OCC. INC.
(School)
ROXAS ST., BRGY. 6, MOISES PADILLA, NEG. OCC.
(School Address)
PARENTAL CONSENT
Date: January 3, 2024
To Whom It May Concern:
I/We hereby willingly and voluntarily give consent to the participation of my/our
son/daughter JEFPOY D. BITONGGA in SWIMMING BOYS n all School Sports Meets
up to the Palarong Pambansa.
I/We have considered the benefits that my son or daughter will derive from
his/her participation in this activity provided that due care, diligence and necessary
precautions will be observed to ensure his/her health and safety.
Further, I/We authorize the personnel of Department of Education to collect,
process, retain, and dispose of personal information of the above-mentioned athlete in
accordance with the Data Privacy Act of 2012.
JAIME B. BITONGGA DIVLACIA G. DIVINAGRACIA
Signature of Father Over Printed Signature of Mother Over Printed Name
Name
Verified:
JAYRA MAY T. SISTOSO ARMIE GRACE B. TINGSON
Adviser School Head/Registrar
(Signature Over Printed Name) (Signature Over Printed Name)
Remarks:
Note:
Submit the necessary documents, i.e. Affidavit/Sworn Statement of Actual Care and Custody duly verified
by the adviser and school head, in cases signature of parents are unavailable.
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
Republic of the Philippines
DEPARTMENT OF EDUCATION
VI – WESTERN VISAYAS
(Region)
NEGROS OCCIDENTAL
(Division)
SAN ISIDRO ACADEMY OF MOISES PADILLA, NEG. OCC. INC.
(School)
ROXAS ST., BRGY. 6, MOISES PADILLA, NEG. OCC.
(School Address)
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
