Republic of the Philippines

LEYTE NORMAL UNIVERSITY

Republic of the Philippines
Republic of the Philippines
CollegeUNIVERSITY
LEYTE NORMAL of Education
LEYTE NORMAL UNIVERSITY
INTEGRATED
College ofLABORATORY
Education College ofSCHOOL
Education
Tacloban City
Tacloban
Tacloban City City

PARENTS’/GUARDIANS’ PERMIT FORM

______Semester,
SY_______
PLEASE TAKE NOTE OF THE FOLLOWING:
1. Please fill out this form in BLOCK LETTERS and in triplicate.
2. ALL sections MUST BE FILLED OUT COMPLETELY.
3. Permits for ILS PUPILS/STUDENTS TO ATTEND THE ON-SITE CLASSES.
4. If the student involved is a MINOR, parents MUST sign the permission form.

To Whom This May Concern:

I/We, ___________________________ & _______________________________, parent/s/legal guardian/s of _________________
________________________________________, a student under the College of Education – Integrated Laboratory School with Student
Number_______________, hereby give/s permission to my/our daughter/son to attend the 2-day on-site classes of the LNU-ILS based on the
scheduled shift for Grade ___.

Printed Name of Adviser Signature

________________________________________ ____________________________________

Further, I/we fully understand that I/we cannot hold the university administrators and instructors liable for any unforeseen/untoward
incidents beyond our control.

IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this ______________________in ______________________________,
(Date) (Place)
Philippines.

________________________________________
Name and Signature of Parent/Guardian #1
________________________________________
Complete Address
________________________________________
Contact Number
________________________________________
ID Type & Number
________________________________________
Name and Signature of Parent/Guardian #2
________________________________________
Complete Address
________________________________________
Contact Number
________________________________________
ID Type & Number

J U R A T
SUBSCRIBED AND SWORN TO before me this _______________________________ in __________________________________
(Date) (Place)
Philippines, affiant/s exhibiting to me the above-mentioned identification card/s as competent evidence of identity.

DOC. No. _________________

PAGE No. _________________
BOOK No._________________
SERIES OF_________________ Notary Public