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Revised as of March 8, 2018.

Previous edition obsolete.

General Instructions:

Please have this form filled out by your parent or legal guardian and have it notarized by a
lawyer/notary public. This form shall be required upon enrollment to the University and shall be
required each and every semester thereafter. Student Identification Cards shall not be validated if
the form is not submitted or erroneously filled out. Please note that Late ID Validation is considered
an offense under existing University policies.


City of _______________ ) s.s.
x ---- ----------------x


I, ____________________, of legal age, Filipino, single or married (please check)

to _________________________, and resident of
______________________________________, after having been duly sworn to in accordance
with law, hereby depose and say:

1) I am the (please check)

o Parent
o Legal Guardian based on the records of the University
of ______________________________ (name of student);

2) My child/ward is presently enrolled at the Ateneo de Davao University this

o First Semester
o Second Semester
o Summer
of SY __________________;

3) In the course of his/her stay at the Ateneo de Davao University, he/she will be
attending various school activities, both academic and non-academic and which will
bring him/her outside the campus, such as but not limited to:

a. Recollections/Retreat;
b. Research;
c. Sports activities or games;
d. Outreach programs;
e. Club activities.

4) In compliance with CHED Memorandum No. 63, I hereby declare that I am allowing
him/her to attend such activity provided that the same is sanctioned by the Ateneo
de Davao University and provided further that I am subsequently provided a
Parent’s Consent Form per activity which need not anymore be notarized;

5) I am executing this affidavit to attest to the veracity of the foregoing facts, in

compliance with the requirements of the Commission on Higher Education, and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________ at

_______________, Philippines.

Signature over Printed Name
Gov’t ID ______________

SUBSCRIBED AND SWORN to before me this __________________, at

__________________, Philippines, by the affiant who exhibited to me his/her competent proof of
identity as shown above.

Doc No.__________;
Book No._________;
Page No._________;
Series of _____.
Revised as of March 8, 2018.
Previous edition obsolete.
Revised as of March 8, 2018.
Previous edition obsolete.

Revised as of March 8, 2018.

Previous edition obsolete.