Republic of the Philippines

CENTRAL BICOL STATE UNIVERSITY OF AGRICULTURE

Impig, Sipocot, Camarines Sur 4408
Website: www.cbsua.edu.ph
Email Address: cbsua.sipocot@cbsua.edu.ph
Trunkline: (054) 881-6681

OFFICE OF STUDENT AFFAIRS AND SERVICES

Control No. _____

CONSENT OF PARENTS OR GUARDIAN

I, _________________________________________ of legal age, a resident of

______________________________________________________ and parent / guardian of
_______________________________who is a student of Central Bicol State University of Agriculture -
College of _____________________________________, consent and permit my son/daughter to
attend/go to __________________________________________________________ at
___________________________________________.

As such, I am not holding the College of ____________________________________ of

Central Bicol State University of Agriculture from any responsibility concerning my son/daughter’s
conduct and any untoward or uncontrolled circumstances that may happen during the duration of the
_________________________________________________________________________________.

_________________________________________
Signature over Printed Name of Parent /Guardian

OSA-FR-011a Rev.: 1
Effectivity Date: May 2, 2022 Page 1 of 1

Republic of the Philippines

CENTRAL BICOL STATE UNIVERSITY OF AGRICULTURE
Impig, Sipocot, Camarines Sur 4408
Website: www.cbsua.edu.ph
Email Address: cbsua.sipocot@cbsua.edu.ph
Trunkline: (054) 881-6681

OFFICE OF STUDENT AFFAIRS AND SERVICES

Control No. _____

CONSENT OF PARENTS OR GUARDIAN

I, _________________________________________ of legal age, a resident of

______________________________________________________ and parent / guardian of
_______________________________who is a student of Central Bicol State University of Agriculture -
College of _____________________________________, consent and permit my son/daughter to
attend/go to __________________________________________________________ at
___________________________________________.

As such, I am not holding the College of ____________________________________ of

Central Bicol State University of Agriculture from any responsibility concerning my son/daughter’s
conduct and any untoward or uncontrolled circumstances that may happen during the duration of the
_________________________________________________________________________________.

_________________________________________
OSA-FR-011a Rev.: 1
Effectivity Date: May 2, 2022 Page 1 of 1
 Republic of the Philippines
CENTRAL BICOL STATE UNIVERSITY OF AGRICULTURE
Impig, Sipocot, Camarines Sur 4408
Website: www.cbsua.edu.ph
Email Address: cbsua.sipocot@cbsua.edu.ph
Trunkline: (054) 881-6681

Signature over Printed Name of Parent /Guardian

OSA-FR-011a Rev.: 1
Effectivity Date: May 2, 2022 Page 2 of 1