PARENTAL CONSENT FORM

Name of Student / Athlete: __Ñina Nadine M. Teves___ Student Number: ____2020101239______

Course: _Bachelor of Science in Exercise and Sports Science_ Year and Section: ____2B_______

Name of Sport: _____BASKETBALL WOMEN____________________________________________

Nature of Sport: Training

Competition
Seminar / Workshop
Others: _____________________________

Venue: _BULACAN STATE UNIVERSITY____ Inclusive Dates: ____________________

To be filled – up by the Parent / Guardian:

I allow my son / daughter to attend the activity.

I trust that the organizer of this activity will take due diligence to ensure the safety of my
son / daughter as a participant. I also agree to absolve the university from legal
responsibility on any untoward incident in the course of the event.

I do not allow my son / daughter to attend the activity.

Name of Parent / Guardian: __________Maria Victoria M. Teves___________________

Phone / Cell phone number(s): ___09365403397__________________________

Address: ______0706, Mother Rita Homes Look 1st City Of Malolos_________________

Specimen Signatures: _______________ ________________ _______________

Note:
Please affix a photocopy of the Parent’s / Guardian’s identification card with signature.

BulSU – OP – SDO – 02F1

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