DAVAO ORIENTAL

STATE UNIVERSITY
PARENT’S CONSENT

REPUBLIC OF THE PHILIPPINES }

DOSCST, City of Mati, Davao Oriental } S.S.
x----------------------------------------------x

AFFIDAVIT OF CONSENT

I/We ________________________________________________ the parent(s)/guardian(s) of

(Name of Parent(s)/Guardian)
___________________________________ do hereby grant permission for his/her participation in the
(Name of Student)
___________________________________________________ to be held on __________________
(Nature of the Activity) (Date)
at _________________________________________________________________________.
(Venue)

I hereby warrant to the best of my knowledge, that he/she is in good health, and I assume all
responsibility for his/her health. In the event of an emergency, I hereby give permission to transport
him/her to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any
further treatment by the hospital or doctor. In the event of an emergency and you are unable to reach me,
contact:
________________________________________ at ___________________.
(Name and Relationship) (Phone Number)

IN WITNESS HEREOF, I have hereunto set my hand this __________________ at

City of Mati, Davao Oriental, Philippines.

________________________________
Affiant

SUBSCRIBED AND SWORN to before me, this ________________ at City of Mati, Davo
Oriental, Philippines. Affiant exhibited me his/her ____________________ issued at
________________________________ Philippines on ___________________.

Doc No. _________: Notary Public _________:

Page No._________: Until _________:
Book No. ________: PTR No. _________:
Series of: ________. At__________, Davao Oriental