University of Science and Technology of Southern Philippines

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

PARENT/GUARDIAN CONSENT REQUEST FORM

_____________________
Date
Department of National Service Training Program

TO WHOM IT MAY CONCERN:

This is to certify that I allowed my son / daughter / ward to join the Tree Growing Activity.
(Please specify the name of event/activity here)

Name of son / daughter Leona Gen O. Bayhon

Name of Activity/event Tree Growing
Inclusive Date/s of Activity/event October 22, November 26 & December 3, 2022
Place(s) to Visit USTP-Alubijid Campus
For OJT (Please Write the name N/A
of Company/Industry)
Thank you very much!
Yours truly, APPROVED:
Leona Gen O. Bayhon __________________________
Name of Student Name of Parent/ Guardian
(Signature-Over-Printed Name) (Signature-Over-Printed Name)

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Acknowledgement
I__Leona Gen O. Bayhon (name) presently enrolled in Bachelor of Science in Electorinics Technology -
ES101 (course/ year & section) present myself to join the Tree Growing Activity 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:

Leona Gen O. Bayhon __________________________
Name of Student Name of Parent/ Guardian
(Signature-Over-Printed Name) (Signature-Over-Printed Name)

Copies for Distribution:

1. NSTP 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.