PAMPANGA STATE AGRICULTURAL UNIVERSITY

Office of Student Affairs and Services

Document Control Notice

PARENT’S/GUARDIAN’S CONSENT FORM

I/We, Melinda P. Bonito am/are permitting my/our son/daughter,

(Name of Parent/Guardian)

Mary Joy P. Bonito, BAELS 3rd yr student, to join/attend the following:

(Name of Student) (Course & Section)
DATE ACTIVITY LOCATION
1. October 24, 2022 –
College of Arts and
December 23, 2022 Limited Face-to-Face Classes
Sciences
(1st Semester)
2. January 16, 2023 – College of Arts and
Limited Face-to-Face Classes
May 19, 2023 Sciences

under of the supervision of Ma. Leilani V. Agillon

(Personnel In-Charge)

We Melinda P. Bonito and Mary Joy P. Bonito hold the school free from liabilities from any
untoward incident/s as may be brought about by the said activity.

Melinda P. Bonito Mary Joy P. Bonito

Parent’s Name and Signature Student’s Name and Signature

Date Signed

Ma. Leilani V. Agillon

Personnel-in-charge
Noted:

Sylvia S. De Guzman, Ed. D

College Dean/Chair

Arnello S. Valerio, Ed. D

Director, Office of Student Affairs and Services

Republic of the Philippines )

Province of Pampanga ) s.s.
Municipality of Magalang )

SUBSCRIBED AND SWORN to before this ____________ at Magalang, Pampanga by

Mary Joy P. Bonito with Pampanga State Agricultural University Student ID No.
C202000423 S.Y. 2022-2023, who personally appeared to me to be the same person who
personally signed before me the foregoing instrument and acknowledged that he/she
executed the same.

PSAU-OSS-SF-01 | 00 (02-22-21)
 PAMPANGA STATE AGRICULTURAL UNIVERSITY
Office of Student Affairs and Services

NOTARY PUBLIC
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SERIES OF 20__

PSAU-OSS-SF-01 | 00 (02-22-21)