Republic of the Philippines

Province of Davao del Norte

Municipality of Kapalong
-oOo-
No. SDS-PC-10

KAPALONG COLLEGE OF AGRICULTURE, SCIENCES, AND TECHNOLOGY

Maniki, Kapalong, Davao del Norte
Email add:kcast.kapalong@yahoo.com
OFFICE OF THE STUDENT DEVELOPMENT AND SERVICES
PARENTAL CONSENT
FOR OFF-CAMPUS ACTIVITIES

I am allowing my son/daughter, ___________________________________________________ with ID

Number _________________ from the College of __________________________________ to join and
Participate in: _______________________________________________________________
Sponsoring unit: _____________________________________________________________
Nature of Activity: ____________________________________________________________
Duration of Activity: ___________________________________________________________
Date / Time of Activity: ________________________________________________________
Venue/ Address of the Activity: __________________________________________________
Instructor/ Staff In-Charge: _____________________________________________________
Cost/ Contribution (if any): _____________________________________________________

Together with my son/daughter, I know that the school and its faculty and staff are expected to
exercise the legal diligence required for the safety and well-being of my son/daughter for the duration and
the place, date, and time of the activity as stated.
This legal diligence would include oral or written instructions, whether given below or during the
activity, that if followed, would ensure the safety of my son/daughter.
If my son/daughter, disregards or fails to follow those instructions or should act on his/her own, I,
together with my son/daughter, shall have no claims against the school, faculty & staff-in-charge should any
damage be caused or liability incurred to property or person.

Signature above Printed Name Date Signature above Printed Name Date
of Parent/ Guardian of Student

SUBSCRIBED AND SWORN to before me, this ______________, by _______________ who

Exhibited me (his/ her) competent proof of identification ___________________________ issued at
__________________, Philippines on _________________________.

Notary Public

Doc No. ___________;

Page No. __________;
Book No. __________,
Series of __________;