Southern Luzon State University

GRADUATING BATCH OFFICERS

Lucban, Quezon
Batch 2022

SLSU GRADUATION PICTORIAL

PARENTAL GUARDIAN CONSENT

Name of Student: Jalbuena, Arjay R.

Parent/Guardian Name: Teodora R. Jalbuena
Parent/Guardian Contact Number: 09619985209
Home Address: Brgy. San Diego Zone-II, Tayabas City, Quezon
Subject: SLSU Graduation Pictorial

Good day!
I, Teodora R. Jalbuena (Name of Parents/Guardian), as a guardian of my son/daughter Jalbuena,
Arjay R, a student in the SLSU Tayabas City campus (College/Campus) under the program of
Bachelor of Science in Agriculture major in Crop Science (Course) is allowing my son/daughter
to travel from Brgy. San Diego Zone-II, Tayabas City (Address) to Southern Luzon State
University-Main Campus.
I acknowledge and assume the risk of this travel for my son/daughter. Therefore, he/she must
comply with Southern Luzon State University protocols and highly observed the required health
standards. By granting this permission, I also waive any claims against and RELEASE AND
HOLD HARMLESS AND INDEMNIFY, Southern Luzon State University from any liability,
claims, demands and cause of action arising out or relating to any loss, damage or injury
sustained in connection with or arising out of my son’s/daughter’s participation in the said
pictorial.

Teodora R. Jalbuena
Signature of Parent or Guardian:
Date: 07 – 02 – 22
Southern Luzon State University
GRADUATING BATCH OFFICERS
Lucban, Quezon
Batch 2022