Republic of the Philippines

PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
Intramuros, Manila
Telefax No. 526-68-82
OFFICE OF THE STUDENT AND DEVELOPMENT SERVICES
COLLEGE

: College of Engineering and Technology

ACITIVITY

: ChE Lab II Experiment

______
DATE

: September 14, 2016 (Wednesday)

TIME

: 8:00 AM 5:00 PM

VENUE
REMARKS

: De La Salle University, Manila__________________

:

______________________________________________________________________________
PARENTAL CONSENT
We allow our son/daughter _
_____________________________with Student Number _
_ from (College) College
of Engineering and Technology
taking up (degree program) ___BS Chemical
Engineering____ to join the _ ChE Lab II Experiment_ on September 14, 2016_
at _ De La Salle University, Manila_.

We voluntarily and knowingly waive all rights of actions against the school,
its faculty member/s. employees. officials, and administrators for any injury
or damage, as well as costs, expenses and liabilities which may incur during
or as a result of the event / field trip.
In case of emergency:
Name of contact person
:
________________________
Relationship
:
______________________
Contact Number
:
__

__
__

_______
______________________________

We dont allow our son / daughter _____________________ to join the

event/fieldtrip.

______________________________________
PARENTS SIGNATURE OVER PRINTED NAME

___________________
DATE

Note: Not valid without the photocopied parents identification card.