OSA Form 06

PARENT/GUARDIAN CONSENT REQUEST FORM

_______________
Date
Department: NATIONAL SERVICE TRAINING PROGRAM (NSTP)
Component/Unit: Civic Welfare Training Service (CWTS)
Literacy Training Service (LTS)

TO WHOM IT MAY CONCERN:

This is to certify that I allowed my son/daughter/ward to join the NSTP 101 Activities during the 1st
semester, AY 2019-2020 indicated below:

Name of son / daughter

Name of Activity/event 1st Semester Activities
Tree Planting/Growing***
Clean-up Drive (Costal or Inland)
Inclusive Date/s of Activity/event Tree-Planting - September 2019***
Clean-up Drive – November 2019
Place(s) to Visit Cagayan de Oro City
For OJT (Please Write the name N/A
of Company/Industry)
Thank you very much!

Yours truly, APPROVED:

______________________________ __________________________
Name of Student Name of Parent/ Guardian
(Signature-Over-Printed Name) (Signature-Over-Printed Name)

Note to Parents:1. *** Specific venue and date of the activity will be announced after receiving Memo from CHED-10).
2. Students will proceed to the area/venue of the activity. Attendance will be checked in the venue.
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Acknowledgement
I,________________________ (name) presently enrolled in ____________________________ (course/ year
& section) present myself to join the _________________________as part of our school / student activity and
1. Do hereby pledge to obey and abide the rules and regulations promulgated, enforced by the officials of the University
for the protection and safety of all;
2. That I understand that should I violate the guidelines and policies, that I be dealt with accordingly;
3. That should I have clarifications regarding the activity/event, it is my responsibility to inquire from concerned
authorities/organizers.

Thank you very much!

Yours truly, Noted by:

______________________________ __________________________
Name of Student Name of Parent/ Guardian
(Signature-Over-Printed Name) (Signature-Over-Printed Name)

Copies for Distribution:

1. College file
2. Office of the Student Affairs
3. Student file

SUBSCRIBED AND SWORN to before me this_____ day of _______,____ in the City of Cagayan de Oro .

Doc. No. __________ Note: for off-

campus
Page No. __________ activities/OJT
Book No. __________ please have
this form
Series of __________ notarized
before
submitting to
OSA with the
SARF (for
Student Orgs
Only)and
other
required
documents.