PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my

son/daughter_________________________________ in the Two-Day Scholars Formation
Name of Scholar

Program under the Department of Science and Technology-Science Education Institute to be

held at BarCIE Hotel, La Consolacion University, Philippines, Catmon, Malolos City, Bulacan
on August 30-31, 2017.

I have considered the benefits that my son/daughter will derive from his/her participation
in this activity with the understanding that due care and precaution will be observed to ensure the
comfort and safety of the participants.

_______________________ ______________________
Signature of Father Signature of Mother

_______________________ ______________________
Name of Father Name of Mother

_______________________ ______________________
Date Date

_________________________________
Signature of Guardian over Printed name

_________________________________
Relationship with the student

_________________
Date

Verified by:

PROF. NIEL KENNETH F. JAMANDRE

Project Director, UP-DOST Core Group
__________
Date