University of Science and Technology of Southern Philippines

Alubijid | Cagayan de Oro | Claveria | Jasaan | Oroquieta | Panaon

PARENT/GUARDIAN CONSENT REQUEST FORM

Department of National Service Training Program-ROTC. Date: JANUARY 24, 2023

TO WHOM IT MAY CONCERN:

This is to certify that I allowed my son / daughter / ward to join the Cadet Officer Qualifying
Course.

Name of son / daughter CADENAS, AIZA MITCH L.

Name of Activity/event Cadet Officer Qualifying Course Training
Inclusive Date/s of Activity/event January 30- February 3, 2023
Place(s) to Visit 10RCDG, 4ID Camp Evangelista, Patag, CDO
For OJT (Please Write the name N/A
of Company/Industry)

Thank you very much!

Yours truly, APPROVED:

AIZA MITCH L. CADENAS MARIA SALOME. CADENAS

Name of Student Name of Parent/ Guardian
(Signature-Over-Printed Name) (Signature-Over-Printed Name)
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Acknowledgement
I, __AIZA MITCH L. CADENAS__, presently enrolled in BS ENERGY SYSTEM MANAGEMENT
MAJOR IN ELECTRIC MACHINE CONTROL AND MAINTENANCE/1st YEAR/ CT_EMCM1Q1
present myself to join the ROTC Training as part of our school / student activity and
1. Do hereby pledge to obey and abide the rules and regulations promulgated, enforced by
the officials of the University for the protection and safety of all;
2. That I understand that should I violate the guidelines and policies that I be dealt with
accordingly.
3. That I should strictly always observe the health protocols; and
4. That should I have clarifications regarding the activity/event, it is my responsibility to
inquire from concerned authorities/organizers.

Thank you very much!

Yours truly, Noted by:

AIZA MITCH L. CADENAS MARIA SALOME L. CADENAS

Name of Student Name of Parent/ Guardian
(Signature-Over-Printed Name) (Signature-Over-Printed Name)

Copies for Distribution:

1. College file
2. Office of the Stunt Affairs
3. Student file

SUBSCRIBED AND SWORN to before me this ________ day of ____, ______ in the City of Cagayan
de Oro.

Note: for off-campus activities/OJT

please have this form notarized before
submitting to OSA with the SARF (for
Student Orgs Only) and other required
documents.