eens os OnSCFOM-SAS ety Date: Auge 5, 2088 ewsen o. 0
Control Number: PC-24-
CONSENT OF PARENT OR GUARDIAN
TO ALL CONCERNED:
EEE een sess nen enEnEseneenEEIEPLESEEEEDg ELE PRL ALG
Rama Free en]
formy child / ward _ a
ame of ey
a student of
Tear ves Progen)
of the of this College, to undergo / participate
Compu
student internship / local off-campus activity
(ame of te actin?
at on
(Place of rain pace a vis aclon afte event) Datey
I understand that my child / ward
ie oo
has been properly oriented on all the rules and regulations of the program and will comply with
the same; otherwise, he/she shall be excluded from further participation.
1 hereby further agree that if in case that he/she is on the age of maturity, he/she shall be
made answerable for any and all liabilities for damages to property or injury to himselfVherself, to
the College ot its representatives, and/or to third persons which may be caused by his/her
intentional or negligent act while in the course of the implementation of the program.
If in case that he/she is a minor, I will take full accountability on any and all liabilities
caused by his/her intentional or negligent act while in the course of the implementation of the
program.
IN WITNESS HEREOF, Ihave hereunto affixed my signature this day
of, 20___ in San Jose, Occidental Mindoro.
Parent’ s/Guardian’s signature over printed name
Contact Number:
Address:
SUBSCRIBED AND SWORN TO BEFORE ME, this___ day of
20__, and affiant exhibited to me his/her ___ issued on
at
NOTARY PUBLIC