NORTHWESTERN UNIVERSITY

Laoag City

I. INTERNATIONAL TRIP INFORMATION

Event: EDUCATIONAL TOUR FOR TOTAL QUALITY MANAGEMENT AND WORLD TOURISM CLASS
Purposes:
A. to help in students enchance and broaden the vision of the school;
B. to enable students to experience and understand global scenario from a different
cultural perspective;
C. to provide students with cross-cultural exposure and opportunities to expand their
horizons; and
D. to learn and understand the global techniques with respect to their field and equip
them with the traits required for working in a global environment
Destination: SEOUL, SOUTH KOREA
Date: NOVEMBER 10, 2019 to NOVEMBER 14, 2019
Personnel-in-charge: DR. ERIC S. PARILLA, DEAN, COBE Contact No.: ___________________

II. STUDENT INFORMATION

Name of student: ____________________________________ Course & Year: ______________
Contact No.: ________________ Address: ___________________________________________

III. MEDICAL/EMERGENCY INFORMATION

Does the student have any medical or physical condition, medication information, or allergies
which could interfere with the student’s safety?  Yes  None
If yes, please describe: ___________________________________________________________
______________________________________________________________________________

In case of emergency, please contact the person below:

Name: _______________________ Contact No.: ____________ Relationship: _______________

____________________________________
University Physician/Private Physician

IV. INFORMED CONSENT

I hereby understand that this educational tour is not mandatory to all students although it is
part of the curriculum of the students.

I hereby give my permission to the above-named student to participate in the international

educational trip as described above. As the parent/guardian of the student, I have read the itinerary
(Annex “A”) and will voluntarily pay the sum of $570 (PhP30,000.00) for the trip inclusive of
accommodation, food, air fare, and visa processing to the partner travel agency.

I further understand that there are risks of physical injury associated with participation in these
activities. In case of injury or serious illness, I authorize qualified emergency medical
professionals to examine and administer emergency care to the student. I understand every effort
will be made to contact me to explain the nature of the problem prior to any involved treatment. In
the event it becomes necessary to give emergency care to the student, neither he/she nor the school
assumes financial liability for expenses incurred by reason of the accident, injury, illness and/or

***Please attach photocopy of government-issued ID of parent/guardian (i.e. TIN Card, SSS/GSIS,

Voter’s ID, Senior Citizen’s ID, Driver’s License, Passport, etc.)
 NORTHWESTERN UNIVERSITY
Laoag City

unforeseen circumstances. This activity is an extension of the school education program and the
student’s conduct is to be in accordance with the school’s published rules and regulations.

_________________________________________
Signature over Printed Name of Parent/Guardian

_________________________________________
Date Signed

_________________________________________
Contact Number

_________________________________________
Address

I pledge that my conduct will, at all times, reflect credit upon myself, my parents, and my
school. I understand that the school’s rule of conduct apply while on the trip.

________________________________________
Signature over Printed Name of Student

________________________________________
Date Signed

Signed in the presence of :

__________________________________ ____________________________________

Republic of the Philippines )

City of Laoag ) SS.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the City of Laoag, this __________________
personally appeared _______________________________ (Name of Parent/Guardian) with
government-issued ID ______________________ (Type of ID) ID No. _____________________
issued on ___________________ at ______________________, known to me and to me known to be
the same person who executed the foregoing instrument, and he/she acknowledged that the same is
his/her voluntary act and deed. This instrument consists of two (2) pages and has been signed on each
and every page hereof.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.

***Please attach photocopy of government-issued ID of parent/guardian (i.e. TIN Card, SSS/GSIS,

Voter’s ID, Senior Citizen’s ID, Driver’s License, Passport, etc.)