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    Activity Information & Consent Activity Information & Consent

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    Grim Warrior
    This document is a consent form for student participation in service-learning or community engagement activities. It provides important information about the activity such as the title, dates, times, location, and description. The form requires signatures from the student, parent or guardian, and the faculty or staff in charge of the activity to provide permission and acknowledgement of risks. Contact information for the parent or guardian is also collected.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Activity Information & Consent Activity Information & Consent

    Uploaded by

    Grim Warrior
    10 views1 page
    This document is a consent form for student participation in service-learning or community engagement activities. It provides important information about the activity such as the title, dates, times, location, and description. The form requires signatures from the student, parent or guardian, and the faculty or staff in charge of the activity to provide permission and acknowledgement of risks. Contact information for the parent or guardian is also collected.

    Original Description:

    "Your Advantage is the Advantage of this existing World."

    Original Title

    Planning

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    This document is a consent form for student participation in service-learning or community engagement activities. It provides important information about the activity such as the title, dates, times, location, and description. The form requires signatures from the student, parent or guardian, and the faculty or staff in charge of the activity to provide permission and acknowledgement of risks. Contact information for the parent or guardian is also collected.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    10 views1 page

    Activity Information & Consent Activity Information & Consent

    Uploaded by

    Grim Warrior
    This document is a consent form for student participation in service-learning or community engagement activities. It provides important information about the activity such as the title, dates, times, location, and description. The form requires signatures from the student, parent or guardian, and the faculty or staff in charge of the activity to provide permission and acknowledgement of risks. Contact information for the parent or guardian is also collected.

    Copyright:

    © All Rights Reserved
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    REVISION NO.: 03 REVISION NO.

    : 03
    REVISION DATE: August 14, 20 18
    REVISION DATE: August 14, 20 18

    ACTIVITY INFORMATION & CONSENT ACTIVITY INFORMATION & CONSENT


    IMPORTANT INFORMATION IMPORTANT INFORMATION
     THIS FORM SHOULD BE FILLED -OUT BY THE PROPONENT(S) OF THE SERVICE-LEARNING OR CO MMUNITY ENGAGEMENT  THIS FORM SHOULD BE FILLED -OUT BY THE PROPONENT(S) OF THE SERVICE-LEARNING OR CO MMUNITY ENGAGEMENT
    INITIATIVE OR BY CSCE. INITIATIVE OR BY CSCE.
     THIS FORM SHOULD BE DULY ACCOMPLISHED BEFORE THE ACTUAL CONDUCT OF THE FIELDWORK ACTIVITY RELATED TO A  THIS FORM SHOULD BE DULY ACCOMPLISHED BEFORE THE ACTUAL CONDUCT OF THE FIELDWORK ACTIVITY RELATED TO A
    SERVICE-LEARNING OR CO MMUNITY ENGAGEMENT INITIATIVE. SERVICE-LEARNING OR CO MMUNITY ENGAGEMENT INITIATIVE.
     USE THE SPACE PROVI DED FOR REMARKS TO INDICATE SPECIAL INSTRUCTIONS / REQUESTS / IMPORTANT INFORMATION /  USE THE SPACE PROVI DED FOR REMARKS TO INDICATE SPECIAL INSTRUCTIONS / REQUESTS / IMPORTANT INFORMATION /
    REQUIREMENTS BY CO NCERNED INDIVIDUALS. REQUIREMENTS BY CO NCERNED INDIVIDUALS.

    TITLE OF SERVICE-LEARNING / TITLE OF SERVICE-LEARNING /


    COMMUNITY ENGAGEMENT INITIATIVE COMMUNITY ENGAGEMENT INITIATIVE

    DATE(S) & TIME(S) OF THE ACTIVITY DATE(S) & TIME(S) OF THE ACTIVITY

    LOCATION LOCATION

    FACULTY / EMPLOYEE / FACULTY / EMPLOYEE /


    FACILITATOR-IN-CHARGE FACILITATOR-IN-CHARGE

    DECSRIPTION OF THE ACTIVITY DECSRIPTION OF THE ACTIVITY

    REMARKS REMARKS

    Signature over Printed Name of Student Signature over Printed Name of Student
    (include course & section for (include course & section for
    SL/NSTP activities) SL/NSTP activities)

    I, the undersigned, have reviewed all of the above information and have approved of I, the undersigned, have reviewed all of the above information and have approved of
    the details and itinerary. I am aware of the risks inherent in participating in this activity . I the details and itinerary. I am aware of the risks inherent in participating in this activity . I
    hereby give my permission for my son/daughter to participate in this activity. hereby give my permission for my son/daughter to participate in this activity.

    SIGNATURE OVER CONTACT SIGNATURE OVER CONTACT


    PRINTED NAME OF DETAIL(S) OF PRINTED NAME OF DETAIL(S) OF
    PARENT / GUARDIAN PARENT / PARENT / GUARDIAN PARENT /
    AND DATE SIGNED GUARDIAN AND DATE SIGNED GUARDIAN

    COPY: (1) PARENT OR GUARDIAN; (2) CSCE CSCE-040A/B-04 COPY: (1) PARENT OR GUARDIAN; (2) CSCE CSCE-040A/B-04

    THIS FORM IS AVAILABLE AT THE CENTER FOR SERVICE-LEARNING AND COMMUNITY ENGAGEMENT. THIS FORM IS AVAILABLE AT THE CENTER FOR SERVICE-LEARNING AND COMMUNITY ENGAGEMENT.

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