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DepEd Parental Consent and Waiver Form on the Pilot Implementation of Face-to-Face Classes

The Department of Education (DepEd) announces the Operational Guidelines on the Implementation of Limited Face-to-Face Learning Modality for School Year 2021-2022. The full DepEd-DOH Joint Memorandum can be read here.

Attached herewith are the Parental Consent and Waiver Form on the Pilot Implementation of Face-to-Face Classes for School Year 2021-2022.

DepEd Parental Consent and Waiver Form on the Pilot Implementation of Face-to-Face Classes

The comments and inputs of Legal Affairs are confined only to the legal aspects of this document, and exclude from their coverage the medical, technical, operational, policy and ethical aspects of the document.

Pilot Implementation of Face-to-Face Classes (English)

The [NAME OF SCHOOL] recently underwent a location risk assessment and school safety assessment, and has received approval from the Department of Education and Department of Health to conduct face-to-face classes. This affirms that our school is compliant with the minimum public health standards set by the government.

In light of this, the [NAME OF SCHOOL] will participate in the pilot implementation of face-to-face classes. This activity aims to further develop strategies, understand key considerations of stakeholders, and identify resources required for the effective and efficient transition of learners from distance learning to expanded face-to-face classes.

This activity will be conducted for a maximum of two months in schools that were carefully selected to be in areas classified as minimal risk from COVID-19 and can offer diverse perspectives based on their local context and best practices.

DURATION

The pilot face-to-face classes will be held from [START DATE] to [END DATE] every [DAYS e.g. Monday, Wednesday], from [START TIME] to [END TIME].

BENEFITS

This activity will address difficulties of learners in learning independently through pure distance learning and lack of access to technology and household resources. Moreover, our learners will benefit in the future from the information from this activity.

CONFIDENTIALITY

Any information that will be given during the activity will be kept strictly confidential, and personal information will be treated in accordance with the Data Privacy Act of 2012. Be assured that information about you or your child will not be shared outside of the implementation team. The participant’s name will not be used when data from this activity will be analyzed.

VOLUNTARY PARTICIPATION

Participation in this activity is voluntary. You or your child may decline to participate or to withdraw from participation at any time for any reason. Declining or withdrawal of participation will not result to any penalty, or loss of benefits or reduction of any basic right to which your child is entitled.

If you or your child decide to withdraw participation, kindly inform the teacher adviser of your child.

EXCLUSION (LIMITATIONS/INELIGIBILITY)

In accordance with the health and safety protocols, children with existing comorbidities should NOT participate in the Pilot Implementation of Limited Face-to-Face Learning Modality.

Children who tested positive of COVID-19 or who have household members who tested positive of COVID-19 shall follow the required quarantine period consistent with the latest national guidelines on Return to School / Work Policies and as provided in Section 7.4.6 Strategy to Reintegrate of the Guidelines and must be cleared by a licensed medical doctor before they may participate. The same applies to children who tested positive during the actual implementation.

Parents/guardians shall sign a health form at the beginning of each school term confirming that their child and/or any member of their household is not considered as a close contact, suspect, probable, or confirmed COVID-19 case in the past fourteen (14) days, and does not experience any symptoms related to COVID-19 such as, but not limited to, fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea before being permitted to participate in the limited face-to-face classes.

RISKS, CONSENT AND WAIVER

As the parent or legal guardian of , I hereby acknowledge that I have been informed of the details of the

conduct of Pilot Implementation of Face-to-Face Learning Modality.

I understand that [NAME OF SCHOOL] shall implement the minimum public health standards set by the government to minimize risk of the spread of COVID-19, but it cannot guarantee that my child will not become infected with COVID-19, given that COVID-19 is highly contagious.

I understand that my child/ren’s in-person attendance in school will include associating with teachers, fellow learners and school personnel, and other persons inside and outside of the school that may put my child at risk of COVID-19 transmission, notwithstanding the precautions undertaken by the school.

I acknowledge that my child/ren’s participation in this activity is completely voluntary. While there remains the risk of possible COVID-19 transmission to my child/ren, and to the members of my household, I freely assume the said risk and I permit my child/ren to attend school under this activity.

I am aware that symptoms of COVID-19 include, but are not limited to, fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea.

I confirm that my child/ren currently has none of those symptoms, and is in good health. I will not allow my child/ren to physically go to school to attend classes if my child/ren or any member of my household develops any of the said symptoms or any other symptoms of illness that may or may not be related to COVID-19. I will also inform the school and not allow my child/ren to attend face-to-face classes if my child/ren or any of my household members tests positive for COVID-19. My child/ren and I, with my household members, will follow the required health and safety protocols and procedures adopted by the school and our community.

To the extent allowed by law and rules, I hereby agree to waive, release, and discharge any and all claims, causes of action, damages, and rights against the school and its personnel as well as officials and personnel of the Department of Education relative to the conduct of the activity.

With full understanding, I – on behalf of myself, my household members, and my child/ren – hereby freely and voluntarily give my consent to my child/ren’s participation in the activity from [START DATE] to [END DATE]. I also attest that I had sought the views of my child/ren and he/she has expressed willingness to participate in the activity.

CONTACT DETAILS FOR QUESTIONS OR PROBLEMS

For any concern or clarification, you may contact Policy Research and Development Division-Planning Service through email address ps.prd@deped.gov.ph.

Parental Consent aPaunang Implementasyon NG Harapang Pagkaklase (Tagalog)

Kamakailan lamang ay sumailalim ang [PANGALAN NG PAARALAN] sa location risk assessment at school safety assessment at naaprubahang magsagawa ng harapang pagkaklase (face-to-face classes) ng Kagawaran ng Edukasyon at ng Kagawaran ng Kalusugan. Ito ay nagpapatunay na ang aming paaralan ay sumusunod sa pampublikong pamantayang pangkalusugan (minimum public health standards) na itinakda ng pamahalaan.

Kaugnay nito, ang [PANGALAN NG PAARALAN] ay lalahok sa paunang implementasyon ng harapang pagkaklase. Ang gawaing ito ay naglalayong paunlarin ang mga estratehiya, maunawaan ang mahahalagang konsiderasyon ng mga stakeholder, at matukoy ang mga kagamitang kinakailangan para sa mabisa at mahusay na transisyon ng mga mag-aaral mula sa distance learning patungo sa mas malawak na pagpapatupad ng harapang pagkaklase (expanded face-to-face classes).

Isasagawa ang gawaing ito nang hindi lalampas sa dalawang buwan sa mga paaralang maingat na pinili sa mga lugar na tinukoy na may pinakamababang panganib sa COVID-19 at makapagbibigay ng iba’t ibang pananaw batay sa kanilang lokal na konteksto at pinakamahuhusay na pamamaraan.

DURASYON/ITINAKDANG HABA NG PANAHON NG IMPLEMENTASYON

Ang harapang pagkaklase ay isasagawa simula [PETSA NG SIMULA] hanggang [PETSA NG PAGTATAPOS] tuwing [MGA ARAW hal. Lunes, Miyerkules], sa ganap na [ORAS NG SIMULA] hanggang [ORAS NG PAGTATAPOS].

MGA BENEPISYO

Tutugunan ng gawaing ito ang mga suliranin ng mga mag-aaral sa sariling pagkatuto at kakulangan sa magagamit na teknolohiya at mga kagamitan sa bahay. Dagdag pa rito, makikinabang sa hinaharap ang ating mga mag-aaral mula sa impormasyong makakalap sa gawaing ito.

PAGKAKUMPIDENSIYAL

Anumang impormasyong ibibigay habang isinasagawa ang gawaing ito ay pananatilihing kumpidensiyal, at ang personal na impormasyon ay gagamitin nang naayon sa Data Privacy Act of 2012. Makatitiyak na ang mga impormasyon tungkol sa iyo at sa iyong anak ay hindi ilalabas ng implementation team. Ang pangalan ng kalahok ay hindi gagamitin sa pagsusuri ng mga datos sa gawaing ito.

BOLUNTARYONG PAGLAHOK

Boluntaryo ang paglahok sa gawaing ito. Ikaw at ang iyong anak ay maaaring tumanggi o umatras sa paglahok sa anumang oras sa anumang dahilan. Ang pagtanggi o pag-atras sa gawaing ito ay hindi magkakaroon ng anumang parusa, o hindi mawawala ang anumang benepisyong nararapat para sa iyong anak.

Kung napagpasyahan mo o ng iyong anak na umatras sa paglahok, mangyaring ipaalam sa gurong tagapayo (teacher adviser) ng iyong anak.

MGA LIMITASYON/MGA HINDI MAAARING MAPILING LUMAHOK

Sang-ayon sa mga protokol na pangkalusugan at pangkaligtasan (health and safety protocols), HINDI pinahihintulutang lumahok ang mga mag-aaral na may comorbidities sa Paunang Implementasyon ng Pamamaraang Harapang Pagkaklase.

Ang mga mag-aaral na nagpositibo sa COVID-19 o mayroong kasama sa bahay na nagpositibo sa COVID-19 ay mahigpit na susundin ang quarantine period na naaayon sa mga alituntuning ipinatutupad sa buong bansa patungkol sa Return to School / Work Policies at sa Seksyon 7.4.6 Strategy to Reintegrate ng Guidelines, at kailangang mabigyang pahintulot ng lisensyadong medikal na doktor na lumahok sa gawaing ito. Ang mga alituntunin ding ito ang susundin ng isang batang magpopositibo sa COVID-19 habang isinasagawa na ang gawaing ito.

Bago pahintulutan ang paglahok sa limitadong harapang pagkaklase, sasagot ng health form ang mga magulang o legal na tagapangalaga bago magsimula ang harapang pagkaklase, na magpapatunay na ang kanyang anak at ang kanilang mga kasama sa bahay ay hindi close contact, suspect, probable o confirmed COVID-19 case sa nakaraang labing-apat (14) na araw, at hindi nakararanas ng sintomas na kaugnay ng COVID-19 kabilang na ang, ngunit hindi limitado sa, lagnat, pag-ubo, pangangapos ng hininga, pagkapagod, pananakit at pagkirot ng katawaan o kalamnan, pagkawala ng panlasa o pang-amoy, pananakit ng lalamunan (sore throat), sipon o baradong ilong, pagduduwal, pagsusuka, at pagtatae.

MGA PANGANIB, PAGBIBIGAY NG PAHINTULOT (CONSENT) AT WAIVER

Pinatutunayan sa pamamagitan nito, na bilang magulang o legal na tagapangalaga ni/nina ay

ipinaalam sa akin ang mga detalye ng pagsasagawa ng Paunang Implementasyon ng Pamamaraang Harapang Pagkaklase.

Nauunawaan kong ipatutupad ng [PANGALAN NG PAARALAN] ang mga pampublikong pamantayang pangkalusugan na itinakda ng pamahalaan, subalit hindi nito matitiyak na hindi mahahawahan ng COVID-19 ang aking anak, sapagkat lubhang nakahahawa ang COVID-19.

Nauunawaan kong kabilang sa harapang pagdalo sa mga klase ng aking anak/mga anak ang pakikihalubilo sa mga guro, kamag-aral at mga empleyado ng paaralan, at iba pang tao sa loob at labas ng paaralan na maaaring magdulot ng pagkahawa ng aking anak sa COVID-19, sa kabila ng mga pag-iingat na isinasagawa ng paaralan.

Nauunawaan kong ganap na boluntaryo ang paglahok ng aking anak/mga anak sa gawaing ito. Bagamat nananatili ang posibilidad ng pagkahawa sa COVID-19 ng aking anak/mga anak, at ng aming mga kasama sa bahay, tinatanggap ko ang mga kaakibat nitong panganib (freely assume the risk) at pinahihintulutan kong lumahok ang aking anak/mga anak sa gawaing ito.

Batid ko ang mga sintomas ng COVID-19 kung saan kabilang ang, ngunit hindi limitado sa, lagnat, pag-ubo, pangangapos ng hininga, pagkapagod, pananakit at pagkirot ng katawaan o kalamnan, pagkawala ng panlasa o pang-amoy, pananakit ng lalamunan (sore throat), sipon o baradong ilong, pagduduwal, pagsusuka, at pagtatae.

Kinukumpirma ko na ang aking anak/mga anak ay wala ng mga nabanggit na sintomas, at kasalukuyang may mabuting kalusugan. Hindi ko pahihintulutan ang aking anak/mga anak na harapang pumasok sa paaralan kung ang aking anak/mga anak o sinumang kasama sa bahay ang makaranas ng mga nabanggit na sintomas o makaranas ng iba pang sintomas na maaaring may kaugnayan sa COVID-19. Ipaaalam ko sa paaralan ang aming kundisyon at hindi ko pahihintulutang lumahok sa harapang klase ang aking anak/mga anak kung siya/sila o sinumang kasama sa bahay ay magpositibo sa COVID-19. Ako, ang aking anak/mga anak at ang aming mga kasama sa bahay, ay susunod sa mga protokol na pangkalusugan at pangkaligtasan at sa mga pamamaraang isinasagawa ng paaralan at ng aming komunidad.

Sa hangganang pinahihintulutan sa ilalim ng batas at ng mga patakaran, sumasang-ayon ako na talikuran ang anumang paghahabla o paghahabol at lubusan kong tinatalikuran ang anumang karapatan, paghahabol, anumang usapin o pagsasampa ng kaso laban sa paaralan, mga empleyado at opisyal nito, at sa Kagawaran ng Edukasyon kaugnay sa pagpapatupad ng gawaing ito.

Dahil naunawaan ko ang lahat ng mga nabanggit, ipinapahayag ko – sa ngalan ng aking sarili, mga kasama sa aking bahay, at ng aking anak – ang aking malaya at boluntaryong pagpapahintulot sa paglahok ng aking anak/mga anak sa gawaing ito simula [PETSA NG SIMULA] hanggang [PETSA NG PAGTATAPOS]. Pinatototohanan kong sumangguni ako sa opinyon ng aking anak at nagpahayag siya ng kanyang pagsang-ayon sa paglahok sa gawaing ito.

MGA DETALYENG MAAARING MAKONTAK PARA SA MGA TANONG O SULIRANIN

Para sa anumang tanong o paglilinaw, maaaring makipag-ugnayan sa Policy Research and Development Division-Planning Service sa pamamagitan ng email address na ps.prd@deped.gov.ph.

Download the DepEd Parental Consent and Waiver Form

Annex-C-Parental-Consent-and-Waiver-Form

Sample Health Form

Annex-G_-Sample-Health-Form

READ MORE:

DepEd Class Schedules and Timetables on the Limited Face-to-Face Learning Modality

DepEd Class Scheduling on the Limited Face-to-Face Learning Modality

DepEd Classroom Layout and Structure on the Limited Face-To-Face Learning Modality

DepEd Guidelines on the Implementation of Limited Face-to-Face Learning Modality

Mark Anthony Llego

He is the brain of TeacherPH. Growing up being surrounded by educators, a passion for education has grown in him. Mark spends his time writing and spreading online articles about the educational world. He likes emphasizing critical political issues that involve issued on the educational system of the country. Join Our Facebook Discussion Group

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