NATIONAL SERVICE TRAINING PROGRAM 2

NSTP PARENT/GUARDIAN CONSENT FORM

NSTP 2: Community Immersion
National Training Service Program (NSTP2) is a three – unit non – academics course for students
who have taken National Training Service Program 1. It requires the actual involvement of the students in
community projects and activities designed to encourage the youth to contribute to the improvement of the
general welfare and the quality of life for local and its various institutional components, more particularly, in
terms of improving health, education, environment, entrepreneurship, safety, recreation, and moral of the
citizenry (RA No.9163, Section 3, d). In compliance with the approved Implementing Rules and Regulation
(IRR) improved last November 13, 2009, in accordance with Republic Act No. 9163.

In line with this, NU MOA as an institution abiding to the Philippine Constitution will create
opportunities for our NSTP 2 students to immerse themselves in the community, honing learners who will
embody not only the Nationalian Identity but also Patriotism, Nationalism, and Genuine Care for the
community.
Instructions
1. Accomplish all information being asked herein.

2. This form should be accomplished and submitted to the NSTP Office before the conduction of
Community Immersion Program.

3. Provide attachment of Parent’s Identification Card for verification.

Student’s Information
Student’s Name: Miah Vouchelle O. Aguilucho Year and Section: 1st yr Mar234
Course: BSBA major in Marketing Contact Number: 09208188909
Parent/Guardian Information
Custodian Parent/Guardian’s Name: Dolores Aguilucho
Home Address: Bacoor City, Cavite
Contact Information: +63 920 818 8909
I, the undersigned parent/guardian of Miah Vouchelle O. Aguilucho, do hereby authorize my
son/daughter to participate in off – campus activities related to NSTP 2 Community Immersion. I understand
that by signing this consent form, I am allowing my son/daughter to travel within and/or outside of Metro
Manila and I have been informed of the details regarding the off-campus activity, including the destination/s,
mode/s of transportation, name/s of adult chaperone/s, and time and place of departure and return. I
understand that during this off-campus activity, my son/daughter will be under the direction and general
supervision of the NSTP Office, and adult chaperone/s selected by the school representatives. I fully
understand that my son/daughter is subject to discipline for his/her conduct during the activity.

I hereby authorize the NSTP Office to use my data and my son’s/daughter’s data for documentation
purposes. In case photographs of my son/daughter are included in any online promotion, I do give consent in
such posting, but I also have the right to revoke this consent if I think it will endanger my child’s safety.

In the event my son/daughter needs medical attention during the off-campus activity, I hereby give
my permission to the NSTP Office representatives for the trip to take my son/daughter to a physician,
hospital, or other medical institution for treatment. I expressly authorize all medical treatment which a
physician may determine necessary under the circumstances. I understand that in time that the representative
may not be able to reach out, I give them authority to take medical action under the supervision of a medical
professional. I also understand that I am responsible for all medical expenses incurred in treating my
son/daughter.

Dolores Aguilucho|April 12,2024

 NATIONAL SERVICE TRAINING PROGRAM 2

Signature over Printed Name of Parent/Guardian and Date of Signing

Name of Emergency Contact in case the Consenting Parent/Guardian is not available: Christopher Apolinario
Contact Number of Emergency Contact: 09959078487
Additional Medical Instructions from Parent/Guardian
Allergies: Dust, poor pollution

Note: If she has an asthma attack give her salbutamol through anebulizer.

Proof of Identity of Parent/Guardian

I hereby certify that all information given herein is true and correct.

Dolores Aguilucho|April 12,2024

Signature over Printed Name of Parent/Guardian and Date of Signing