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SCIENCE AND TECHNOLOGY CENTER (STEC)

Basak, Lapu-Lapu City

SENIOR HIGH SCHOOL DEPARTMENT

PARENT/GUARDIAN IMMERSION CONSENT FORM

Instruction: Please complete the following, sign and return to:.


Mr. Bryant C. Acar, STEC Immersion Coordinator

Name of student: _____________________ Age: ____________

Name of Parent/Guardian: ________________________________

Address: ___________________________________
Mobile: ____________________________________

Family Doctor …………………………………………… Doctor’s Tel No: …………………………........


Does your child suffer from any medical conditions/allergies that the teacher/
trainer should be aware of (including any current medication

.........................................................................................................
Please provide details of medication that must be administered:

_____________________________________________________________________
Emergency contact details: (If different from above)

Name: ……………………………………………………………… Telephone no: ……………..…………


Relationship to child: ……………………………………………………………………………….................

CONSENT (please read carefully)

a) I agree to my son/ daughter taking part of the Immersion Program as


requirement of the SHS Curriculum to expose the students to the assigned
company/units and learn new skills relevant to the theory learned in the
classroom
b) I fully support the Work Immersion undertaking of my son/daughter through
minimal financial cost; securing/paying for the Medical Insurance & Uniform
and through my attendance/presence if so desired.
c) I consent to my son/ daughter travelling by any form of public transport,
minibus or motor vehicle by land or water in the course of his/her Work
Immersion.
d) I understand that my son/daughter will undergo an 80 hours/ 2 weeks/10
days Immersion to the assigned company/unit with corresponding School
coordinator and In-Company Trainer

Signed ………………………………….....................… (Parent/ Guardian)

Date: ……………………………

(Append approved Immersion Schedule)