UNIVERSITY OF SOUTHERN MINDANAO

Kabacan, Cotabato
Philippines
ACKNOWLEDGEMENT

I / We, the parent(s) / guardian of ROJAN Q. ANSULA, a 5th year student of the
Department of Civil Engineering, College of Engineering, hereby acknowledge that I am /
we are fully aware that the required Apprenticeship Program to be undertaken by
my/our son/daughter/ward is an integral part of the academic work leading to the
completion of his/her program leading to the degree of Bachelor of Science in Civil
Engineering offered by the College.

Furthermore, I / we acknowledge the following:

That every co-curricular activity that my son/daughter/ward participates in

involves risk or risks which are beyond the control of the College / University;

That I / we fully believe that the management of the College / University leaves
no unturned stone to promote and safeguard the welfare and safety of my/our
son/daughter/ward, most especially during off-campus co-curricular activities, like this
plant visit tour and;

That in case of any untoward incident that may possibly happen during the
conduct of the tour due to circumstances beyond the control of the Plant Visit Tour/or
Faculty chaperone(s), in particular and the University, in general, I / we shall not hold
them liable nor file a complaint against them.

MARY JANE Q. ANSULA

Signature Over Printed Name
PARENTS / GUARDIAN

SUBSCRIBED and SWORN to before this ____day of _______2020, with the

affiant exhibiting to me his/her Community Tax Certificate No._____, issued on
_________________at _____________________.

Doc No. __________

Page No. __________ NOTARY PUBLIC
Book No. __________
Series No. __________

USM-OUP-F02