Philippine Normal University

The National Center for Teacher Education

OFFICE OF STUDENT AFFAIRS & STUDENT SERVICES
Taft Avenue, Manila
Telefax; (02) 5317-1768 loc. 713
Email Address: [email protected]

NAME OF ORGANIZATION

Dear Parents/Guardians:

Your son/daughter has expressed his/her intentions of joining the

(TITLE OF ACTIVITY/EVENT)

sponsored by the _____________________________________________________________ to be held on __________________________________________________________________

(NAME OF SPONSORING CLASS/ORGANIZATION) (DATE)

from ____________________to ____________________ at __________________________________________________________________________________

(TIME) (LOCATION: COMPLETE ADDRESS OF VENUE)

Please note that joining the activity will entail your son/daughter to stay in school or outside of the school premises,
accompanied/unaccompanied by a faculty adviser. Please be advised of your duties and responsibilities as provided in
the statement of consent and undertaking.

Should you allow your son/daughter to join the aforementioned activity, kindly fill-out the attached “Statement of
Parental Consent” and return to___________________________________________________ the ________________________________ _______________________
(NAME OF OFFICER) (POSITION IN THE ORGANIZATION)
of the___________________________________________________________________________________________________________________________________________________
(NAME OF ORGANIZATION)
on or before ___________________________________________ ____________________________________________________________________________________
(DEADLINE FOR SUBMISSION OF PERMIT TO JOIN / PARTICIPATE IN STUDENT ACTIVITY)

Sincerely yours, Noted:

NAME OF FACULTY ADVISER ASSOCIATE DEAN/INSTITUTE DIRECTOR

(Signature Over Printed) (Signature Over Printed)

(All documents without the PNU QM Stamp or Control Identifier are uncontrolled)
 Philippine Normal University
The National Center for Teacher Education
OFFICE OF STUDENT AFFAIRS & STUDENT SERVICES
Taft Avenue, Manila
Telefax; (02) 5317-1768 loc. 713
Email Address: [email protected]

WAIVER FORM/PARENT PERMIT

VISIT / ENTRY TO _________________________________

Name of Student : ______________________________________

Signature of Student : ______________________________________

Date Signed : ______________________________________

Course/Year/Section : ______________________________________

Contact Number : ______________________________________

PhilHealth ID Number (if available) : ______________________________________

Person-in-charge : _____________________________________________

Contact Number : ______________________________________

===================================================================

 I am allowing my son/daughter to visit _______________________________on ___________________

from _______________________to _______________________________ with the purpose/s of participating
in the _________________________________________________________________________________________________
________________________________________________________________________________________________________

 I fully understand that the Philippine Normal University or PNU is committed to undertake
the necessary measure to ensure the safety and well-being of my son/daughter, and
exercise the diligence of a good parent required of it under the law.
 By allowing my son/daughter to visit__________________________________, I acknowledge and
accept all the risks to and from the University. With this, I waive and fully release any and
all rights or claim of any nature whatsoever, I may have against the University, and its
members, agents and employees, in connection with, or resulting upon my son/daughter
from visiting the_________________________________.

 My signature below indicates that I DO NOT HOLD PNU ACOUNTABLE for any untoward
incident such as but not limited to illness, injury or damage that may occur as a result of
his/her visiting the_______________________________.

Printed Name of Parent : _______________________________________

Signature of Parent : _______________________________________

Date Signed : _______________________________________

Contact Number : _______________________________________

Note: Please attach photocopy of parent’s valid ID, student’s vaccination ID, and PhilHealth ID (if
child is still covered) and/or student’s Philhealth ID/Health insurance (if available)

(All documents without the PNU QM Stamp or Control Identifier are uncontrolled)
 Philippine Normal University
The National Center for Teacher Education
OFFICE OF STUDENT AFFAIRS & STUDENT SERVICES
Taft Avenue, Manila
Telefax; (02) 5317-1768 loc. 713
Email Address: [email protected]

Photocopy of parent’s valid ID

Student’s vaccination ID
(if available)

PhilHealth ID (if child is still

covered) and/or
student’s Philhealth ID/Health
insurance (if available)

(All documents without the PNU QM Stamp or Control Identifier are uncontrolled)