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Parent'S Permit: Tacloban City Title of Form: Parent's Permit Control No. EVSU-SASO-F-026 Revision No. 0 Date

This document is a parent's permit form from Eastern Visayas State University allowing a student to participate in an unspecified activity. It notes that safety precautions will be taken but the school is not responsible for unforeseen incidents. The bottom portion is a medical certificate verifying the student's physical fitness to participate, with space for notes on their health status and any treatment or restrictions.

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Mee Lai Calinao
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253 views1 page

Parent'S Permit: Tacloban City Title of Form: Parent's Permit Control No. EVSU-SASO-F-026 Revision No. 0 Date

This document is a parent's permit form from Eastern Visayas State University allowing a student to participate in an unspecified activity. It notes that safety precautions will be taken but the school is not responsible for unforeseen incidents. The bottom portion is a medical certificate verifying the student's physical fitness to participate, with space for notes on their health status and any treatment or restrictions.

Uploaded by

Mee Lai Calinao
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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EASTERN VISAYAS STATE UNIVERSITY

Tacloban City

Control No. EVSU-SASO-F-026


Title of Form: Parent’s Permit Revision No. 0
Date -

PARENT’S PERMIT

We/I hereby grant permission to our daughter/son ______________________________ to participate in the


_______________________________ to be held at __________________ on ____________________

We/I fully understand that all the necessary precautions will be taken into consideration to ensure safety and well-being of my /
our child for the duration of the said activity. However, we/I cannot hold the chaperon or instruction or companion of the school
responsibility for any incident or unforeseen circumstances that may happen beyond control.

_________________________________
Parents / Authorized Guardian

I hereby certify that the signature that appears above is therefore genuine

____________________________________________________
Signature over Printed Name of the Student

_______________________________________
Signature over Printed name of the Adviser

Recommending Approval:

________________________________________________ ________________________________________________
Signature over Printed Name of the Dept, Head Signature over Printed Name of the College Dean

Approved:

____________________________
Head, Student Affairs Office

Medical Section
MEDICAL CERTIFICATE
Date:_________________

This is to certify that, _________________________________________________ years old from EASTERN VISAYAS STATE
UNIVERSITY- _________________________ came in to this clinic on _____________________________ for

( ) Physical Examination ( ) Treatment as out-patient

IMPRESSION/ DIAGNOSIS:

REMARKS/DISPOSITION: ( ) Physically and mentally fit / unit


( ) Advised continuous treatment at home and regular check-up
( ) Advised rest for ________________ days/ weeks/ months

______________________
Medical Officer lll
License No. 82635
PTR No.

ACKNOWLEDGEMENT
Republic of the Philippines)
City of Tacloban ) SS.

SUBSCRIBED AND SWORN to before this ________________________________ day of ________, 2019


________________________________________ , Philippines.

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