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    2 Activity Information and Consent Form PDF

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    Ty Tricia
    This document is a consent form for student participation in service-learning or community engagement activities. It requires basic information about the activity such as title, dates, location, description, and contact information for the faculty member in charge. The form must be signed by the student and parent/guardian to provide permission for the student to participate and acknowledgement of the inherent risks. Copies are to be provided to the parent/guardian and the Center of Service-Learning and Community Engagement.

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

    2 Activity Information and Consent Form PDF

    Uploaded by

    Ty Tricia
    15 views1 page
    This document is a consent form for student participation in service-learning or community engagement activities. It requires basic information about the activity such as title, dates, location, description, and contact information for the faculty member in charge. The form must be signed by the student and parent/guardian to provide permission for the student to participate and acknowledgement of the inherent risks. Copies are to be provided to the parent/guardian and the Center of Service-Learning and Community Engagement.

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    2-ACTIVITY-INFORMATION-AND-CONSENT-FORM.pdf

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    © © All Rights Reserved

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    This document is a consent form for student participation in service-learning or community engagement activities. It requires basic information about the activity such as title, dates, location, description, and contact information for the faculty member in charge. The form must be signed by the student and parent/guardian to provide permission for the student to participate and acknowledgement of the inherent risks. Copies are to be provided to the parent/guardian and the Center of Service-Learning and Community Engagement.

    Copyright:

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

    2 Activity Information and Consent Form PDF

    Uploaded by

    Ty Tricia
    This document is a consent form for student participation in service-learning or community engagement activities. It requires basic information about the activity such as title, dates, location, description, and contact information for the faculty member in charge. The form must be signed by the student and parent/guardian to provide permission for the student to participate and acknowledgement of the inherent risks. Copies are to be provided to the parent/guardian and the Center of Service-Learning and Community Engagement.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Revision No: Revision No:

    Revision Date: Revision Date:

    ACTIVITY INFORMATION & CONSENT ACTIVITY INFORMATION & CONSENT


    Importan Information: Importan Information:
    - THIS FORM SHOULD BE FILLED-OUT BY THE PROPONENT(S) OF THE SERVICE-LEARNING OR COMMUNITY - THIS FORM SHOULD BE FILLED-OUT BY THE PROPONENT(S) OF THE SERVICE-LEARNING OR COMMUNITY
    ENGAGEMENT INITIATIVE OR BY CSCE. ENGAGEMENT INITIATIVE OR BY CSCE.
    - THIS FORM SHOULD BE DULY ACCOMPLISHED BEFORE THE ACTUAL CONDUCT OF THE FIELDWORK - THIS FORM SHOULD BE DULY ACCOMPLISHED BEFORE THE ACTUAL CONDUCT OF THE FIELDWORK
    ACTIVITY RELATED TO A SERVICE-LEARNING OR COMMUNITY ENGAGEMENT INITIATIVE. ACTIVITY RELATED TO A SERVICE-LEARNING OR COMMUNITY ENGAGEMENT INITIATIVE.
    - USE THE SPACE PROVIDED FOR REMARKS TO INDICATE SPECIAL INSTRUCTIONS / REQUESTS / - USE THE SPACE PROVIDED FOR REMARKS TO INDICATE SPECIAL INSTRUCTIONS / REQUESTS /
    IMPORTANT INFORMATION / REQUIREMENTS BY CONCERNED INDIVIDUALS IMPORTANT INFORMATION / REQUIREMENTS BY CONCERNED INDIVIDUALS

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


    ENGAGEMENT INITIATIVE ENGAGEMENT INITIATIVE

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

    LOCATION LOCATION

    FACULTY / EMPLOYEE / FACILITATOR-IN- FACULTY / EMPLOYEE / FACILITATOR-IN-


    CHARGE 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 SL/NSTP (include course & section for SL/NSTP
    activities activities

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

    SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME


    CONTACT DETAIL(S) OF CONTACT DETAIL(S) OF
    OF PARENT/ GUARDIAN AND OF PARENT/ GUARDIAN AND
    PARENT / GUARDIAN PARENT / GUARDIAN
    DATE SIGNED DATE SIGNED

    COPY: (1) PARENT OR GUARDIAN; (2) CSCE FORM CSCE-002 COPY: (1) PARENT OR GUARDIAN; (2) CSCE FORM CSCE-002

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

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