Document No.
WVSU-OSA-SOI-02-F02
PARENT’S/ GUARDIAN’S
Issue No. 1
CONSENT
Revision No. 2
Date of Effectivity June 30, 2023
WEST VISAYAS STATE
Issued by: OSA
UNIVERSITY
Page no. Page 1 of 1
Address
Contact Number
Date
Name of Faculty In-Charge
Section/ Name of Student Organization
Sir/Madam:
The undersigned allows ________________________________________________
(Name of Student)
to participate in ____________________________________________________________
(Activity)
which shall be held at ________________________________________________________
(Place/Venue)
on at .
(date) (time)
I have considered the benefits that my son/daughter/ward may derive from his/her
participation and/or the experiences that he/she may gain from the activity, and that the
school will not be liable for any untoward incident that may happen to the student beyond
their control during the duration of the activity.
__________________________________
Signature over Printed Name of Parent/Guardian
Note: for Off- Campus Activities
REPUBLIC OF THE PHILIPPINES
( S.S)
BEFORE ME, Notary Public for and in the city and Province of
__________________, this ______________ at personally appeared
with CTC No. ___________ issued at
on .
Known to me to be the same person who executed the forgoing instrument and they
acknowledge that the same in their free and voluntary act and deed.
WITNESS MY HAND AND SEAL
Notary Public
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