UsTP ‘University of Science and Technology of Southern Philippines Alabipd | CageyandeCOvo | Clavoria | Jaenan | Grospoiota | Panaon PARENT/GUARDIAN CONSENT REQUEST FORM February 28, 2023 Date Department of National Service Training Program ‘TO WHOM IT MAY CONCERN: This is to certify that | allowed my son / daughter / ward to join the ROTC Formation & Tree Planting. (ease spety the mame of evens ere) Name of son 7daughier KENNETH M_CUBILLAN Name of Acivitylevert ROTC Formation, Tree planting, other activities relative to ROTC approved by authorities, Inclusive Date/s of Actviy/event | March 4,11,18 & 25, April 1,15,22 & 29 May 6,13,20 & 27, June 3,10,17, 2023 (other applicable dates as required) Note: Dates are subject to changes upon advisory by authorities Place) to Visit 41D, Camp Evangelisia, Patag, Cagayan de Oro City/ Malasag, ‘Cugman, Cagayan de Oro City For OFT (Please Write the name [N/A ‘of Company/industty) ‘Thank you very much! ‘Yours truly, APPROVED. INETH M. CUBILLAN Name of Student Name of Parent! Guardian (Signature-Over-Printed Name) (Signature-Over-Printed Name) Acknowledgement KENNETH M. CUBILLAN (name) presently enrolled in BS-ME(course/ year & section) present myself to join the ROTC Formation and Tree Planting Activity as part of our school / student activity and 1 Dohereby pledge to obey an abide the mules ans regulations promuyated, entorced by the offal of the University {or the prowction and safety oa 2 That Understand tat should | Violate the guidelines ana polcies that be dealt wn accorangly ‘3 That should strict alvaye observe the heath protocols; and 4 That should | have cariications regarding the activiylevent, it is my responsitilly to inquire fran concerned ‘uthorties/organizee ‘Thank you very much! Yours truly, Noted by: KENNETH M. CUBILLAN Name of Student Name of Parent) Guardian (Signature-Over-Printed Name) (Signature-Over-Printed Name) copes fr ara: SUBSCRIBED AND SWORN to before me this__day of, Inthe City of Cagayan de Oro. ‘lease nave ins om notarized Detore Stang obk nm ne Sartor ‘Sher Ors Onan one enares