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Consent Form

This document contains 3 parental consent forms for Project LOTUS, a tutorial extension project of Sorsogon State University. The forms provide the names, contact details, and signatures of parents consenting to their children's participation. Details about each child such as name, birthdate, age, grade and school are also included. All 3 children are 12-year-olds in Grade 6 at Grefalda Elementary School. Their tutor's name and contact number are also listed.

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Johnray Habol
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© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
33 views

Consent Form

This document contains 3 parental consent forms for Project LOTUS, a tutorial extension project of Sorsogon State University. The forms provide the names, contact details, and signatures of parents consenting to their children's participation. Details about each child such as name, birthdate, age, grade and school are also included. All 3 children are 12-year-olds in Grade 6 at Grefalda Elementary School. Their tutor's name and contact number are also listed.

Uploaded by

Johnray Habol
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

SORSOGON STATE UNIVERSITY


Research, Extension and Training Office
Extension and Training Services Unit
Magsaysay St., Sorsogon City
E-mail Add.: [email protected]

PARENTAL CONSENT FORM and LEARNERS PROFILE

I confirm that I, Abegail Habol (Name) am the parent/guardian of Joshua Habol.

I hereby consent to my child participating in the Project LOTUS (Localized Tutorial Services), an
extension project of Sorsogon State College, Teacher Education Department. I understand that this
activity will be of help to my child’s educational needs.

Name: Please print: Abegail Habol Contact No. 09456573429


Signature: ______________________ Date signed: April 8, 2023

CONTACT DETAILS

Child’s Name: Joshua Habol


Date of Birth: May 15, 2011 Place of Birth: Irosin District Hospital Age: 12 Sex: Male
Year/Grade level: Grade 6 School: Grefalda Elementary School
Address: Sitio Baybay, Tinago, Juban, Sorsogon

Name of Tutor: Johnray B. Habol Contact No. 09380409702

Republic of the Philippines


SORSOGON STATE UNIVERSITY
Research, Extension and Training Office
Extension and Training Services Unit
Magsaysay St., Sorsogon City
E-mail Add.: [email protected]

PARENTAL CONSENT FORM and LEARNERS PROFILE

I confirm that I, Sharon Deputo (Name) am the parent/guardian of Chen Deputo.

I hereby consent to my child participating in the Project LOTUS (Localized Tutorial Services), an
extension project of Sorsogon State College, Teacher Education Department. I understand that this
activity will be of help to my child’s educational needs.

Name: Please print: Sharon Deputo Contact No. 09345672341


Signature: ______________________ Date signed: April 8, 2023

CONTACT DETAILS

Child’s Name: Chen Deputo


Date of Birth: ______________________ Place of Birth: ______________ Age: 12 Sex: Female
Year/Grade level: Grade 6 School: Grefalda Elementary School
Address: Sitio Baybay, Tinago, Juban, Sorsogon

Name of Tutor: Johnray B. Habol Contact No. 09380409702

Republic of the Philippines


SORSOGON STATE UNIVERSITY
Research, Extension and Training Office
Extension and Training Services Unit
Magsaysay St., Sorsogon City
E-mail Add.: [email protected]

PARENTAL CONSENT FORM and LEARNERS PROFILE

I confirm that I, Joy Dugay (Name) am the parent/guardian of Andrey Dugay.

I hereby consent to my child participating in the Project LOTUS (Localized Tutorial Services), an
extension project of Sorsogon State College, Teacher Education Department. I understand that this
activity will be of help to my child’s educational needs.

Name: Please print: Joy Dugay Contact No. 09566576038


Signature: ______________________ Date signed: April 8, 2023

CONTACT DETAILS

Child’s Name: Andrery Dugay


Date of Birth: ______________________ Place of Birth: ______________ Age: 12 Sex: Female
Year/Grade level: Grade 6 School: Grefalda Elementary School
Address: Sitio Baybay, Tinago, Juban, Sorsogon

Name of Tutor: Johnray B. Habol Contact No. 09380409702

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