Parent Consent

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Republic of the Philippines

CENTRAL BICOL STATE UNIVERSITY OF AGRICULTURE


San Jose, Pili, Camarines Sur 4418
Website: www.cbsua.edu.ph
Email Address: [email protected]
Trunkline: (054) 881-6681

College: ____________________________________
Department: ___________________________

CONSENT OF PARENT OR GUARDIAN

I, ______________________________________________, of legal age, a resident


of____________________________________________________ and parent/guardian of
Mr./Ms._______________________________________________, do hereby give him/her
full consent to conduct _____________________________________________________ on
______________________________________ at ____________________________.
I understand that my son/daughter will be guided by the rules on student conduct as if
he/she were in the Central Bicol State University of Agriculture campus and also by the
pertinent rules and regulations of the agency he/she will be __________ his/her
_________________________.
I hereby agree that I will not hold the faculty concerned, the university and the agency
liable for any untoward incident that may happen during the duration of the
_____________________________________________________ which are beyond their
control.
IN WITNESS HEREOF, I have unto signed this parental consent this ________ day of
____________, at ____________________________________________________.

___________________________________
Name and Signature of Parent/Guardian

Witness: __________________________________________________________________

SUBSCRIBED AND SWORN to me this _______ day of __________________, 20___ in the


Municipality of ________________________ Province of ____________________________.

The parent/guardian exhibited to me his/her residence Certificate No. _________ Issued


_____________________on ______________________.

____________________________________
Notary Public

Doc. No. ____________ Until: ____________


Page No. ___________ TIN: _____________

CBSUA-F-OSA-011c Rev.:1
Effectivity Date: May 29, 2020 Page 1 of 1

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