OFFICE OF STUDENT AFFAIRS

PARENTS PERMIT
Title of Activity: 17th Founding Anniversary Organizing Group/ Office/ Class : Student Affairs
Inclusive Dates : November 28-29, 2022 ETD: ETA:
Venue/ Address: University Foot Ball Field/ Binalonan Gymnasium
Nature/ Type of Activity: Fun Run/Student Night

______________________________________ _____________________________ _____________________________

Signature of Guardian Signature of Guardian Signature of Guardian
Fun Run November 28, 2022 Student Night November 28, 2022 Student Night November 29, 2022
4:30AM-7:00AM 6:00PM-11:00PM 6:00PM-11:00PM

I/We hereby confirm to attend the aforementioned activity, and exercise due diligence of a good parent, as required by law, in supervising the implementation of
the school and activity’s rules and regulations, and looking after the safety and well-being of the participants, especially the students.
_____________________________________ College/Office/Departments:
Attending Moderator/ faculty/ Staff representative Contact No:
Signature Over Printed Name Date Signed:
TO THE PARENT/ GUARDIAN: Please check one of the options below to confirm your permission of your child/ward’s attendance to the activity.
[ ] I am permitting my son/daughter/ward to join the above activity. I recognize that the university is committed to exercise due diligence to ensure my child/wards
safety and well-being. However, I understand that the University is not an insurer of all risks and eventualities. Hence, I hereby confirm that I have reminded my
child/ward to follow all the rules and regulations of the school and activity. Should there be any untoward incident as a result of his/her noncompliance of any rules
and regulations, negligence, imprudence, or lack of care, I shall not hold the school responsible for any harm or damage upon him/her in the course of the
aforementioned activity.
[ ] I am not permitting my son/daughter/ward to join the above activity because _____________________________.
Permitted: I attest to the fact that I secured the permission of my parent/ Guardian as
______________________________________ evidenced by his/her signature.
Parent/Guardian
Signature Over Printed Name ____________________________
UEP Student
Signature Over Printed Name
Relation: Student [ ] Mother [ ] father [ ] Others: Pls. Specify: ________ Student I.D. No:
Address: Year & Course:
Contact No: Date Signed: Contact No: Date Signed:

OFFICE OF STUDENT AFFAIRS

PARENTS PERMIT
Title of Activity: 17th Founding Anniversary Organizing Group/ Office/ Class : Student Affairs
Inclusive Dates : November 28-29, 2022 ETD: ETA:
Venue/ Address: University Foot Ball Field/ Binalonan Gymnasium
Nature/ Type of Activity: Fun Run/Student Night

______________________________________ _____________________________ _____________________________

Signature of Guardian Signature of Guardian Signature of Guardian
Fun Run November 28, 2022 Student Night November 28, 2022 Student Night November 29, 2022
4:30AM-7:00AM 6:00PM-11:00PM 6:00PM-11:00PM

I/We hereby confirm to attend the aforementioned activity, and exercise due diligence of a good parent, as required by law, in supervising the implementation of
the school and activity’s rules and regulations, and looking after the safety and well-being of the participants, especially the students.
_____________________________________ College/Office/Departments:
Attending Moderator/ faculty/ Staff representative Contact No:
Signature Over Printed Name Date Signed:
TO THE PARENT/ GUARDIAN: Please check one of the options below to confirm your permission of your child/ward’s attendance to the activity.
[ ] I am permitting my son/daughter/ward to join the above activity. I recognize that the university is committed to exercise due diligence to ensure my child/wards
safety and well-being. However, I understand that the University is not an insurer of all risks and eventualities. Hence, I hereby confirm that I have reminded my
child/ward to follow all the rules and regulations of the school and activity. Should there be any untoward incident as a result of his/her noncompliance of any rules
and regulations, negligence, imprudence, or lack of care, I shall not hold the school responsible for any harm or damage upon him/her in the course of the
aforementioned activity.
[ ] I am not permitting my son/daughter/ward to join the above activity because _____________________________.
Permitted: I attest to the fact that I secured the permission of my parent/ Guardian as
______________________________________ evidenced by his/her signature.
Parent/Guardian
Signature Over Printed Name ____________________________
UEP Student
Signature Over Printed Name
Relation: Student [ ] Mother [ ] father [ ] Others: Pls. Specify: ________ Student I.D. No:
Address: Year & Course:
Contact No: Date Signed: Contact No: Date Signed: