OSAS-QF-25

Republic of the Philippines

CAVITE STATE UNIVERSITY
Don Severino de las Alas Campus
Indang, Cavite, Philippines

( off-campus activity )

STUDENT INFORMATION

LAST NAME FIRST NAME M.I SEX DATE OF BIRTH

Mailing Address STUDENT NUMBER

ACADEMIC

NON- ACADEMIC
CONTACT NUMBER
PERFORMING ARTS
NAME OF ORGANIZATION

NAME & SIGNATURE OF ADVISE DATE : _____________________

PARENT/ GUARDIAN CONSENT

This is to certify that I have full knowledge of and permission for my

son/ daughter/ foster child to join and participate in:

Title of Activity:
______________________________________________________
Date and Time of the Activity:
___________________________________________________
Place of Activity:
______________________________________________________________

I concur and agree on the rules, policies & regulations being

implemented by the concerned organizers.

___________________________ _______________ ________________

Name & Signature of Parent/ Guardian Date Contact Number

Subscribed and sworn to me this ________ day of __________ 2020 at ________________