Scribd
Upload
38 views1 page

Parents or Guardians Permit Form 2

The document is a Parents'/Guardians' Permit Form from Leyte Normal University for students participating in educational tours or field trips. It requires complete information from parents or guardians, including notarization for minors, and outlines the responsibilities and liabilities regarding the student's participation. The form also includes sections for faculty signatures and a jurat for notarization.

Uploaded by

renz
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
38 views1 page

Parents or Guardians Permit Form 2

The document is a Parents'/Guardians' Permit Form from Leyte Normal University for students participating in educational tours or field trips. It requires complete information from parents or guardians, including notarization for minors, and outlines the responsibilities and liabilities regarding the student's participation. The form also includes sections for faculty signatures and a jurat for notarization.

Uploaded by

renz
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
You are on page 1/ 1

LEYTE NORMAL UNIVERSITY

Tacloban City
OFFICE OF THE VICE PRESIDENT
FOR STUDENT DEVELOPMENT
[email protected]
053 888 0855 local 260

PARENTS’/GUARDIANS’ PERMIT FORM

______Semester, SY_______

PLEASE TAKE NOTE OF THE FOLLOWING:


1. Please fill out this form in BLOCK LETTERS and in triplicate.
2. ALL sections MUST BE FILLED OUT COMPLETELY.
3. Permits for Educational Tour/Field Trip purposes and for a participant who is a minor should be notarized.
4. If the student involved is a MINOR, BOTH parents MUST sign the permission form.

To Whom This May Concern:


I/We, _____________________ & _________________________________, parent/s/legal guardian/s of___________________
__________________________________________, a student under the College of __________________________________________
(Student’s Name)
with Student Number__________, and Vaccination Card ID No. __________________/Not Vaccinated [ __] for the following
reasons____________________________________________________, hereby give/s permission to my/our daughter/son/ward to participate/to
attend the _________________________________________ in ______________________________________ on ________________________.
(Event/Activity) (Place/Venue) (Date)
I was/We were made aware that the faculty member/s listed below will accompany him/her in the travel/activity and that adequate
precautionary measures are undertaken to ensure the safety of my/our child/ward.

Printed Name of Faculty Faculty Signature

1. ________________________________________ ____________________________________
2. ________________________________________ ____________________________________
3. ________________________________________ ____________________________________
4. ________________________________________ ____________________________________
5. ________________________________________ ____________________________________

Further, I/we fully understand that I/we cannot hold the university administrators and instructors liable for any unforeseen/untoward
incidents due to non-vaccination and other circumstances beyond our control.
IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this ______________________in ______________________________,
(Date) (Place)
Philippines.
________________________________________ ________________________________________
Name and Signature of Parent/Guardian #1 Name and Signature of Parent/Guardian #2
________________________________________ ________________________________________
Complete Address Complete Address
________________________________________ ________________________________________
Contact Number Contact Number
________________________________________ ________________________________________
ID Type & Number ID Type & Number

J U R A T

SUBSCRIBED AND SWORN TO before me this _______________________________ in __________________________________


(Date) (Place)
Philippines, affiant/s exhibiting to me the above-mentioned identification card/s as competent evidence of identity.

DOC. No. _________________


PAGE No. _________________
BOOK No._________________
SERIES OF_________________ Notary Public

F-SDM-013 (08-23-
22)_______________________________________________________________________________

You might also like