EASTERN VISAYAS STATE UNIVERSITY – TANAUAN CAMPUS

Tanauan, Leyte

Control No.
Title of Form: Parent’s Permit Revision No.
Date

We/I hereby grant permission to our daughter/son , to participate in the

SUNDOWN PARTY to be held at EVSU-TC INNER COURT on SEPTEMBER 23, 2023 from 5:00PM – 10:00PM

We/I fully understand that all the necessary precautions will be taken into consideration to ensure safety and well-being of my /
our child for the duration of the said activity. However, we/I cannot hold the chaperon or instruction or companion of the school
responsibility for any incident or unforeseen circumstances that may happen beyond control.

_________________________________
Parents / Authorized Guardian

I hereby certify that the signature that appears above is therefore genuine

_________________________________________________ ________________________________________________
Signature over Printed Name of the Adviser Signature over Printed Name of the Student

Recommending Approval:

__________________________________________
Signature over Printed Name of the Dept., Head

Approved:

MICHEAL B. BATAN, MSIT

Head, Student Affairs and Services Office

ACKNOWLEDGEMENT

Republic of the Philippines)

Tanauan, Leyte ) SS.

SUBSCRIBED AND SWORN to before this ________________________________ day of ________, 20___

________________________________________ , Philippines.