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Consent Filmviewing 5-20-23

1) Malabanias Integrated School is taking 23 students on a field trip to view a film at SM Clark. 2) The students, teachers, and driver must fill out forms with their information before departing and returning from the trip. 3) Parents must provide consent for their children to participate, acknowledging the risks and agreeing to follow rules for safety.

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Mercy Catubig
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61 views3 pages

Consent Filmviewing 5-20-23

1) Malabanias Integrated School is taking 23 students on a field trip to view a film at SM Clark. 2) The students, teachers, and driver must fill out forms with their information before departing and returning from the trip. 3) Parents must provide consent for their children to participate, acknowledging the risks and agreeing to follow rules for safety.

Uploaded by

Mercy Catubig
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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ANNEX B: MANIFEST

All participants shall fill out this form completely before leaving the school
premises and upon return. As necessary, this shall be completed in triplicate for
School Administration, Faculty Member, and Vehicle Driver’s copy.

Name of School: ____Malabanias Integrated School_________________

Title of Activity: Film Viewing

Destination/Venue: (indicate all)__SM Clark

Vehicle Number: __________________________________ No. of Learners: 23___

Departure Date: ___________________________________ Return Date: __________________

Departure Time: __________________________________ Return Time: __________________

Parent/Guardian/Teacher/ Contact Departure Return


Name of Pupil
Others Number/s (Sign) (Sign)
1. Aaron Lance P. Biscocho Mary Dorothy Parker 0991-944-4384
2. James Moe Catubay Marivic C. Madej 0915-909-1150
3. Darius James V. Codilla Jessica Ventura 0939-112-0899
4. Justin Liam G. Garcia Jane G. Gascon 0993-288-3091
5. Kiandrix M. Gonzales Blecelyn M. Gonzales 0995-267-0816
6. Junrain C. Ibe Juanita M. Ibe 0930-282-2031
7. Kurt Rainiel Jabuen Milalyn Jabuen 0998-342-0098
8. Elij Jayieb Khalel D. Movilla Jhoanna Marie Movilla 0961-469-7443
9. Nathaniel Olendan Melissa R. Olendan 0948-771-6881
10. Duke Vaughn G. Pamintuan Debra Pamintuan 0923-574-4545
11. Shane Angelica C. Agsam Nena Cabatingan 0907-517-9677
12. Alexandra S. Balete Jobelle R. Sanalila 0920-111-3899
13. Barbie E. Cerbito Dylene Eguillos 0926-091-5731
14. Ranz Althea B. De Vero Roxan Bayani 0939-448-6644

15. Ma. Jeanelle Eguillos Noel Eguillos 0965-340-7956


16. Miesha Mae G. Gittere Michael James Gittere 0921-834-6244
17.Tiffany Fhate D. Ibarra Josephine J. Ibarra 0946-768-8356
18. Lean Lappay
Lilia Lappay 0938-702-5428

19. Mary Rose L. Latras Michelle Latras 0929-459-5046

20. Alexis C. Parohinog Liezl Castillo 0975-983-9649

21. Liezl Castillo Liezl Castillo 0975-983-9649

22. Debra Pamintuan Debra Pamintuan 0923-574-4545

23. Raijin Ken F. Dadulla Mercy V. Catubig 0932-227-8026

MERCY V. CATUBIG

Adviser

ANNEX C: PARENT’S/GUARDIAN’S CONSENT FORM


Name of Learner:
______________________________________________________________________________________

Date of Birth: ___________________________________________________________________ Sex:


_________________

Parent’s/ Guardian’s Name:


___________________________________________________________________________

Relationship to Learner: ______________________________________________________________________________

Home Address:
________________________________________________________________________________________

Contact Number/s: ___________________________________________________________________________________

Title of the Activity: __________________________________________________________________________________

Venue: _______________________________________________________________ Date of Activity:


_______________

As the parent/guardian of the abovementioned learner, I hereby acknowledge that I have been
informed of the details of the off-campus activity and voluntarily and freely elect to participate in this off-
campus activity. Furthermore, I undersigned the risks associated with an off-campus activity and agree
that the rules and regulations established for the said activity are for the safety and security of the
participants, and thus agree to instruct my child or children to obey them.

Having understood all the aforementioned, I hereby consent to allow my child or children to
participate, acknowledging all of the foregoing. I am also solely responsible for providing travel insurance
and any expenses for my child or children’s participation in the activity.

_____________________________________________ ________________________________
Parent/Guardian’s Name and Signature Date

Notes (other information you may wish to inform the teacher, such as the child’s medical
condition, etc.)

ANNEX C: PARENT’S/GUARDIAN’S CONSENT FORM


Name of Learner:
______________________________________________________________________________________

Date of Birth: ___________________________________________________________________ Sex:


_________________

Parent’s/ Guardian’s Name:


___________________________________________________________________________

Relationship to Learner: ______________________________________________________________________________

Home Address:
________________________________________________________________________________________

Contact Number/s: ___________________________________________________________________________________

Title of the Activity: __________________________________________________________________________________

Venue: _______________________________________________________________ Date of Activity:


_______________

As the parent/guardian of the abovementioned learner, I hereby acknowledge that I have been
informed of the details of the off-campus activity and voluntarily and freely elect to participate in this off-
campus activity. Furthermore, I undersigned the risks associated with an off-campus activity and agree
that the rules and regulations established for the said activity are for the safety and security of the
participants, and thus agree to instruct my child or children to obey them.
Having understood all the aforementioned, I hereby consent to allow my child or children to
participate, acknowledging all of the foregoing. I am also solely responsible for providing travel insurance
and any expenses for my child or children’s participation in the activity.

_____________________________________________ ________________________________
Parent/Guardian’s Name and Signature Date

Notes (other information you may wish to inform the teacher, such as the child’s medical
condition, etc.)

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