Republic of the Philippines

Pangasinan State University

Lingayen Campus
Lingayen, Pangasinan

PARENTS CONSENT FORM

TO WHOM IT MAY CONCERN

This is to inform you that I give my consent to allow my son/daughter

__________________________________ to attend the Film Screening for Blind Soldiers as part of
the NSTP Activity on September 18, 2023, 8 a.m. onwards at SM City Rosales, Rosales Pangasinan.

It is understood that my son/daughter shall abide the rules and regulations that may be imposed
by the faculty-in-charge for the welfare and safety of the group. It is further understood that I fully agree
to waive any responsibility on the part of the university and faculty-in-charge in case any incident
happens during the said event.

_____________________________
Parent/Guardian
(Signature over Printed Name)