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Code: ACA-QF-08
Revision No.: 01
Effective Date: March 21, 2023

PARENT/GUARDIAN’S CONSENT

March 14, 2024

TO WHOM IT MAY CONCERN:

This is to certify that we are the undersigned parents/guardians do hereby give full
consent and permit to our son/daughter ________________________________________ who is a
3rd year BS Tourism Management presently enrolled at Northwest Samar State University to join
the BSTM Educational Tour in Cebu-Bohol on May 4-7, 2024.

Considering the benefits that our son/daughter will get from participating in this
educational activity, we voluntarily waive any claims against any teacher-
chaperon/coordinator/school officials for any untoward incident which may occur during the
course of his/her participation in the field activity. Provided however, that exhaustive efforts,
utmost care, attention and precaution have been undertaken by said teacher-
chaperon/coordinator/school officials to prevent the occurrence of said untoward incident.

Signed this __________ day of __________________, 2024 here in __________________.

___________________________________
Name/Signature of Parents/Guardian

SUBSCRIBED AND SWORN to before me this __________ day of _________________, 2024 at

_____________________________ the parents/guardians exhibiting their Community Tax
Certificates.

________________________________
Notary Public

Rueda Street, Calbayog City, Samar, Philippines | +63 (055) 533 9857 | main@nwssu.edu.ph | www.nwssu.edu.ph