Revised as of November 2022.

Previous edition obsolete.

General Instructions:

Please have this form filled out by your parent or legal guardian and have it notarized by a
lawyer/notary public. This form shall be required upon enrollment to the University and shall be
required each and every semester thereafter. Student Identification Cards shall not be validated if the
form is not submitted or erroneously filled out. Please note that Late ID Validation is considered an
offense under existing University policies. (PREPARE ATLEAST THREE (3) COPIES).

REPUBLIC OF THE PHILIPPINES)

City of ) s.s.
x---------------------------------------- x

PARENT’S CONSENT FORM

I, , of legal age, Filipino, single or married (please check) to

, and resident of ,
after having been duly sworn to in accordance with law, hereby depose and say:

1) I am the (please check) o Parent

o Legal Guardian based on the records of the
University
of (name of student);

2) My child/ward is presently enrolled at the Ateneo de Davao University this o First

Semester
o Second Semester o Summer
of SY ;

3) In the course of his/her stay at the Ateneo de Davao University, he/she will be attending
various school activities, both academic and non-academic and which will bring him/her
outside the campus, such as but not limited to:

a. Recollections/Retreat;
b. Research;
c. Sports activities or games;
d. Outreach programs;
e. Club activities.

4) In compliance with CHED Memorandum No. 63, I hereby declare that I am allowing
him/her to attend such activity provided that the same is sanctioned by the Ateneo de
Davao University and provided further that I am subsequently provided a Parent’s
Consent Form per activity which need not anymore be notarized;

5) I am executing this affidavit to attest to the veracity of the foregoing facts, in compliance
with the requirements of the Commission on Higher Education, and for whatever legal
purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this at

, Philippines.

Signature over Printed Name

Original Signature Required
Gov’t ID

SUBSCRIBED AND SWORN to before me this , at

, Philippines, by the affiant who exhibited to me his/her competent proof of
identity as shown above.

Doc No. ;
Book No. ;
Page No. ;
Series of .
Revised as of November 2022.
Previous edition obsolete.
 Revised as of November 2022.
Previous edition obsolete.

Republic of the Philippines ]

C I T Y O F D A V A O ] ss.
********************
AFFIDAVIT OF UNDERTAKING

I, , of legal age, single, Filipino and a resident of

, hereby depose and say, THAT:

1. I am a student of the Ateneo de Davao University;

2. I will be going to the University during the semester/summer of AY

in order to participate in several student activities, both academic and non-academic, such
as but not limited to:

a. Recollections/Retreat;
b. Research;
c. Sports activities or games;
d. Outreach programs;
e. Club activities.

3. I have attached hereto my Parent’s Consent Form which allows me to participate in the
said activities;

4. I am physically fit and not experiencing any of the symptoms of COVID 19;

5. I am FULLY VACCINATED as indicated in the IATF Guidelines;

6. As such, I hereby undertake to do the following:

a. Bring alcohol/hand sanitizer at all times within the premises of the University;
b. Wear a face mask and face shield at all times within the premises of the University;
c. Practice physical distancing (2 meters) while on campus as prescribed by the IATF
Omnibus Guidelines and EO 33, s. 2020.
d. Enter the campus at 8:00AM and leave by 5:00PM, except when authorized to stay
beyond those hours;
e. Inform the proper school authorities if and when I feel sick and/or experience any
symptoms of COVID 19;
f. Observe the Single-use Plastics (SuP) free policy of the University and its goal of going
waste-free:
g. Avoid congregating with others except when the same is necessary inside the
University;
h. Ensure that photos uploaded in the social media are in compliance with all related
national and local guidelines; and
i. Follow government guidelines and other related government issuances.

7. I am executing this affidavit to attest to the truth of the foregoing facts and for whatever
legal purpose this may serve. I understand that any violation of the same will constitute a
contemptuous disregard of school rules and may subject me to a disciplinary case and may
also subject me to violation of local and national laws.

IN WITNESS WHEREOF, I have hereunto affix my signature this

at , Philippines.

Name & Signature

(INSERT VACCINATION CARD/VACCINATION CERTIFICATE BELOW)

Revised as of November 2022.

Previous edition obsolete.