Republic of the Philippines

ISABELA STATE UNIVERSITY

NATIONAL SERVICE TRAINING SERVICE PROGRAM
Echague Campus

PARENT CONSENT

The Office of the National Service Training Program (NSTP) of Isabela State University- Echague Campus is now on the
phase of implementing its Community Immersion Program for the 2 nd semester of SY 2023-2024. This program includes rendition of
Off-campus Services and Engagements in collaboration with Government Agencies/Offices involved in community improvements,
social developments and emergency responses to calamities and disasters. Relative to the mandates of NSTP Law (RA 9163), this
Community Immersion Program aims to develop and empower the youths in nation building, equipped with sense of leadership and
volunteerism under the principles of nationalism and patriotism through community services and social engagements.

With this, please confirm by setting your consent if you allow your son/daughter to attend and participate.

Name of Child :
Course :
Name of Parent or Guardian : Parent’s Contact No.: ___________________
Address :
Deployment Site :

Does your child have any health or physical-related condition by which this Office should consider not to involve your child
in community immersion? Please put a mark (✓) on the space provided.

( ) NONE. I acknowledge that my son/daughter is fit to attend and participate in Community Immersion Program.
( ) YES (Specify):

CONSENT: Please read carefully before affixing your signature.

1. I understand that the Community Immersion Program of ISU-NSTP Office is in compliance and accordance with the
mandates of NSTP Law (RA 9163),
2. I understand that my son/daughter's involvement and participation to ISU-NSTP Community Immersion aims towards
youths' empowerment through community service and social engagements,
3. I understand that such Community Immersion involves my son/daughter to different activities relative to Civic Welfare
Training Services, Literacy Training Services, and Reserved Officer Training Course as prescribed by the NSTP Law and in
accordance with the implementing rules and regulations set forth by the Commission on Higher Education, and
4. I understand and acknowledge that the school and the whole NSTP workforce, in the exercise of due diligence and beyond
their control and capacity, are not liable nor accountable for any untoward incidents that may happen in the course of the
immersion.

THEREFORE, I CONFIRM and CONSCIOUSLY ALLOW my son/daughter, in consideration to the above-stated health or
physical-related condition of my son/daughter, to attend and participate to any organized Off-Campus Community Immersion
Activities this 2nd Semester of SY 2023-2024.

To attest my consent, I affix my signature this ___th day of February 2024 at Echague, Isabela.

Signature : CTC/ID Presented :

Name : CTC/ID No. :
Relationship :

ACKNOWLEDGMENT

Before me, a Notary Public in the Province of Isabela, personally appeared _________________________________ with Community Tax
Certificate/Identification indicated above, known to me to be the same person who executed the foregoing instrument and hereby acknowledged to
me that the same is his/her free and voluntary act and deed.

WITNESS MY HAND AND NOTARIAL SEAL on _____ day of February 2024 at Echague, Isabela.

Doc. No. ______ NAME OF THE LAWYER

Page No. ______ Notary Public until LICENCE VALIDITY
Book No. ______ IBP Receipt No. ___________/DATE ISSUED/ISSUING CHAPTER
Series of 2024 PTR No. ____________/DATE ISSUED/PLACE OF ISSUEANCE
Atty’s Roll No. ______________
MCLE Compliance No. __________________