College of

Liberal Arts

PARENTS/GUARDIANS CONSENT AND WAIVER

_____SEM, SY
________

PLEASE TAKE NOTE CAREFULLY

1. Please fill up this form in BLOCK LETTERS.
2. ALL sections MUST BE COMPLETED when applicable.
3. Permit should be duly NOTARIZED for Educational Tour/Field Trip purposes and
when participant is a minor.
TO WHOM THIS MAY CONCERN

This certifies that ____________________________________________, a

___________________________ of the College of ____________________________________
with COURSE & YEAR
Student No. ___________________ has the permission of his/her undersigned
parent(s)/guardian(s) to participate and/or attend in the
______________________________________________________ on ________________, 20
_____ in _______________________. This certifies further that risk assessment plans
and necessary safety and precautionary measures have been instituted.

Further, that the following faculty members shall accompany him/her in the
travel.

1. ___________________________________ _____________________________
Faculty Name (Please print) Faculty Signature

2. ___________________________________ _____________________________
Faculty Name (Please print) Faculty Signature

3. ___________________________________ _____________________________
Faculty Name (Please print) Faculty Signature

I/We have honestly and accurately completed all parts of the Parents/Guardians
Permit Form to the best of my/our ability.
1. ___________________________________
_____________________________
Parent/Guardian Signature #1 Date Parent/Guardian
Signature #2 Date

___________________________________
_____________________________
Parent/Guardian Name (please print) Parent/Guardian
Name (please print)