MEDINA COLLEGE IPIL, INC.

Don Andres, Ipil

Zamboanga Sibugay Province

PARENTS CONSENT

I, ___________________________ parent/guardian of __________________________

(Name of Parent/Guardian) (Name of Student)

__________________________, student of Medina College-Ipil, Inc. allows my

(Course & Year)
son/daughter to join the ____________________________ activity of the said
(Name of Activity)
institution on ____________ at ____________________________________________.
(Date) (Venue)

That by these consent, I agree the following:

That I understand that this activity form part of a requirement in _________________;

That I submit my son/daughter to the rules and regulations of the institution;
That in violation thereof, the institution has all the right to disallow my son/daughter
from joining the said activity;
That I will not hold the institution liable for any accidental event may happen during
the duration of the activity or any incident intentionally cause by my son/daughter.

__________________________
(Parent/Guardian)
Noted by:

________________________
(Adviser)

Recommending Approval:

_________________________
(Department Dean)

Approved by:

JUNMAR C. TAGBACAOLA
DSA