Date: __________________________

To: The MSU-IIT Administration

Through: The Adviser Concerned
This is to authorize my son/daughter/sister/brother/ward to attend the following activity:

Student’s Name: ____________________________________________ Activity: __________________________

Venue & Address: __________________________________________ Date: ____________________________
Adviser/Chaperon: _________________________________________ Position: _________________________
I understand that my son/daughter/sister/brother/ward will pay the total amount of_________ as payment for
participating/attending the said activity.

Signature over Printed Name: ___________________________________

Relationship to the student: _____________________________________

Date: __________________________
To: The MSU-IIT Administration
Through: The Adviser Concerned
This is to authorize my son/daughter/sister/brother/ward to attend the following activity:

Student’s Name: ____________________________________________ Activity: __________________________

Venue & Address: __________________________________________ Date: ____________________________
Adviser/Chaperon: _________________________________________ Position: _________________________
I understand that my son/daughter/sister/brother/ward will pay the total amount of_________ as payment for
participating/attending the said activity.

Signature over Printed Name: ___________________________________

Relationship to the student: _____________________________________

Date: __________________________
To: The MSU-IIT Administration
Through: The Adviser Concerned
This is to authorize my son/daughter/sister/brother/ward to attend the following activity:

Student’s Name: ____________________________________________ Activity: __________________________

Venue & Address: __________________________________________ Date: ____________________________
Adviser/Chaperon: _________________________________________ Position: _________________________
I understand that my son/daughter/sister/brother/ward will pay the total amount of_________ as payment for
participating/attending the said activity.

Signature over Printed Name: ___________________________________

Relationship to the student: _____________________________________

Date: __________________________
To: The MSU-IIT Administration
Through: The Adviser Concerned
This is to authorize my son/daughter/sister/brother/ward to attend the following activity:

Student’s Name: ____________________________________________ Activity: __________________________

Venue & Address: __________________________________________ Date: ____________________________
Adviser/Chaperon: _________________________________________ Position: _________________________
I understand that my son/daughter/sister/brother/ward will pay the total amount of_________ as payment for
participating/attending the said activity.

Signature over Printed Name: ___________________________________

Relationship to the student: _____________________________________