Scribd
Upload
34 views1 page

Consent Form for Off-Campus Activities

This document is a consent form for Vincent Nigel B. Azarcon to participate in off-campus activities organized by the school, including details about the program, emergency contacts, and medical conditions. The form confirms that the student is fit to participate and that the parent/guardian accepts responsibility for associated costs. It includes signatures from both the parent and the student, along with contact information and travel details for the activity.

Uploaded by

megazardy3
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
34 views1 page

Consent Form for Off-Campus Activities

This document is a consent form for Vincent Nigel B. Azarcon to participate in off-campus activities organized by the school, including details about the program, emergency contacts, and medical conditions. The form confirms that the student is fit to participate and that the parent/guardian accepts responsibility for associated costs. It includes signatures from both the parent and the student, along with contact information and travel details for the activity.

Uploaded by

megazardy3
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

​ OFFICE OF THE VICE PRESIDENT FOR HIGHER EDUCATION

CONSENT FORM for OUT of CAMPUS ACTIVITIES


*To be used for Curricular and Non Curricular Activities per CMO 63 s. 2017. This includes SLP, AGAPE, NSTP, Retreats and Recollections,
Outreach Activities, and Co-curricular and Extra-curricular Student Organizations’ Activities.
___________________Vincent Nigel B. Azarcon__________________
Name of Student

_____BS-AGRIBUSINESS 2______
Course and Year Level

Home Address: Alumium street, Barra, Opol Contact Number/s: 09369822960 E-mail:
______azarconvincent730@gmail.com__________________________ Does your son/daughter suffer from any
medical conditions/allergies that the program should be aware of? NO
Please specify the conditions/allergens and current medications.
____N/A_________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

EMERGENCY CONTACT DETAILS


Name of Contact Person: _Janet Azarcon Relationship to Student: _Mother Contact Number/s:
09369822960

OFF CAMPUS ACTIVITY PROGRAM DETAILS


Destination/s: EL GAUCHO
_________________________________________________________________________________________________________
Place or Country / countries of Destination
Travel Dates: _APRIL 27, 2025________________ Date ____APRIL 27, 2025_________________ Date of Return
of Departure

Name of Hotel or Host Person Abroad: _________________________________________________ Address/es Abroad:


__________________________________________________________________________________________________
street address(es), city (cities)/province (provinces)/ country (countries)

__________________________________________________________________________________________________
street address(es), city (cities)/province (provinces)/ country (countries)
Contact Details Abroad:
_______________________________Telephone _______________________________________E-mail

INFORMED CONSENT
I/We have read and understood the terms and conditions of the program and all pertinent risks related to the activity.

I/We confirm to the best of my knowledge that my son/ daughter does not suffer from any medical condition
other than those listed above; and that he/she is physically and mentally fit to participate in the activity.

I/We consent for my/our son/ daughter to the use of the specified mode of transportation, food, and lodging for
the activity organised by the School for any event included in the program; and understand that these may change
based on the contingencies of the situation as determined by the proper school authorities.

I/We have instructed my/our son/ daughter to comply with all the established rules and instructions of the School,
the faculty and the persons in charge of the activity.

I/we commit to be responsible for all associated costs required for the activity.

Note: Please affix signature over printed name.


Signed: Conforme (for Students who are 18 years or older) :

Parent/Guardian: Janet Azarcon Student/Participant : Vincent Nigel Azarcon


Date: 04/07/25 Date: 04/07/25

Lucas Hall Rm 103, Corrales Avenue, Cagayan de Oro City, Philippines


tel: (63 88) 853-9800 loc 9294/9295/9296 | email: vphighered@[Link]

You might also like