Republic of the Philippines

Pangasinan State University

BAYAMBANG CAMPUS
Quezon Blvd, Zone IV, Bayambang, Pangasinan
Telefax: (075) 632-0268
Website: http://www.psubc.edu.ph

PARENTAL CONSENT

I hereby willingly and voluntarily give consent to the participation of my son/daughter

_____________________________________________, ____________________________, in the
(Student’s name) (Program/Major/Year/Section)
Field Study Observation.

I have considered the benefits that my son/daughter will derive from his/her participation in this
program of Field Study, provided that due care and precaution will be observed to ensure the comfort
and safety of my son/daughter and that PSU employees and personnel may not be held responsible for
any untoward incident that may happen beyond their control.

___________________________________
Signature of Parent/Guardian over Printed Name

___________________________________
(Relationship with the FS Observer)