QAT Form 8

ARELLANO UNIVERSITY
SENIOR HIGH SCHOOL

PARENT/GUARDIAN PERMISSION

Date:__________

To Whom It May Concern:

THIS IS TO AUTHORIZE AND GRANT PERMISSION to my son/daughter/dependent:

MR./MS_______________________________, a Grade 12 ____________________(state the
track, strand and section) student of Arellano University Senior High School, to join and
participate in the Senior High School curriculum required Work Immersion Program
from__________________________to __________________(state inclusive time and date of
activity).

I HEREBY CERTIFY THAT I have firmly advised my son/daughter/ward to always act with
due diligence, safety, and care, endeavoring at all times to see to it that his/her conduct during
the entire affair/activity shall establish, maintain and contribute to his /her personal and
protection and those of the other participants of the activity.

I HEREBY HOLD THE UNIVERSITY, its officers, teachers, and advisers free and harmless
from any and all claims caused by fortuitous events or other causes or factors beyond their
control.

IN WITNESS WHEREOF, I have hereunto affixed my signature this_______th day of________

at the City of________________________.

______________________________
PARENT/GUARDIAN
(Signature over Printed Name)

SUBSCRIBED AND SWORN to before me this______th day of_______________in the City of

Manila, exhibiting to me his/her___________________________________________________.

Doc. No.____________
Page No.____________
Book No.____________
Series of 2013
QAT Form 8