This is to certify that I willingly allowed my son/daughter _________________________________

to conduct a survey/experiment at ____________________________________ as an essential

part of their study entitled ___________________________ as a requirement in his/her Practical
Research subject. This also certifies that I am well-informed that the said activity will be done
outside the school premises and during those days that they do not have classes so that the
university and their subject teacher will not be accountable of any unwanted incidents that they
are going to experience.

_______________________________ _______________________________________

Printed Name and Signature of the Student Printed Name and Signature of the Parent/Guardian