OFFICE OF Document No.

: FM-SAS-054
STUDENT AFFAIRS AND SERVICES Revision No.: 00
Effectivity Date: May 20, 2022
PARENTS’ WAIVER
Page No. : 1 of 1

WE,
Gerardo O. Ubiña Roda P. Ubiña
Complete Name of Father/Guardian Complete Name of Mother/ Guardian
who are legal parents / guardian of
Geraldine Rose P. Ubiña
Complete Name of the Student

with residence at
Bliss Site Nangalisan Solana Cagayan 3503
Street Barangay Town/ City Province ZIP Code

do hereby, certify that we give full consent for him/her to join in the
MANAGEMENT ACCOUNTING INTERNSHIP
Name of the Activity

which will be held at on

Cagayan Provincial Capitol January 8 to April 15, 2024
Venue of the Activity Date of the Activity

under the following conditions:

1. WE HAVE REMINDED OUR CHILD/ WARD TO FOLLOW THE SAFETY RULES AND POLICIES OF THE
ACTIVITY AS A PROACTIVE MEASURE TOWARDS AVOIDANCE OF ANY UNTOWARD INCIDENT.
2. Our child/ward will be chaperoned/ escorted by Rovelle Concepcion S. Siazon, CPA, DBA faculty
member/personnel of the School of Accountancy, Business and Hospitality.
3. The chaperon/adviser will see to the safety, behavior and physical upkeep of our child/ward as far as
humanly possible
4. Considering the above conditions and the benefits that our child/ward will gain from his/her
participation in the aforementioned activity, and realizing that every precaution will be undertaken by
the chaperon/adviser, we the undersigned parents/guardian of the above-named student hereby give
him/her our consent to attend the said activity.
5. That we assume responsibility and thereby waiving any responsibility for the University of Saint Louis
Tuguegarao or any of its staff for any incident that may happen on the occasion of the said activity
beyond the control of the chaperon/adviser.

I/we certify further that below is/are my/our TRUE AND CORRECT SIGNATURE/S.

Gerardo O. Ubiña Roda P. Ubiña

Parent’s/Guardian’s Signature Over Printed Name Parent’s/Guardian’s Signature Over Printed Name
Contact #: 09650987792 Contact #: 09565783173

Address: Bliss Site, Nangalisan, Solana, Cagayan

Date Accomplished: January 5, 2024