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EASTERN VISAYAS STATE UNIVERSITY

Tacloban City
Control
EVSU-SASO-F-001
No.
Title of Form: Parent’s Permit Revision
No.
01
Date October 27, 2023

We/I hereby grant permission to our daughter/son _________________________________


to participate in the ______________________________ to be held at ________________________
on ____________________

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 Adviser Signature over printed name of Student

Recommending Approval:

________________________________
Signature over printed name of Dept., Head

Approved:

DR. EDNA P. MODINA


Head, Student Affairs and Services Office

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