ACADEMIC PLANNING & SERVICES

[ ] Main [ ✔ ] Branch TAGUM

PARENTAL/GUARDIAN CONSENT

ERGE MARK B. PERALTA 3rd year

I, parent/guardian of _________________________________________, a _____
Name of Student
UNIVERSITY OF MINDANAO TAGUM COLLEGE
student of the __________________________________________________________
College and Program

give my full consent and approval for him/her to attend and participate in an official off-campus
activity of the University of Mindanao (please check one category only):

A. Curricular (Disciplinal)
[ ] Education tours and field trips [✔] Research field work/data gathering
[ ] Local [ ] International [ ] Work immersion (SHS) / Immersion (CHE)
[ ] Practicum, internship and OJT [ ] Externship
[ ] National [ ] Abroad [ ] NSTP (CWTS, ROTC, LTS)
[ ] RLE (nursing/midwifery programs) [ ] Seminars, trainings or conferences
[ ] FS (teacher education programs) [ ] Competitions and contests
[ ] Student exchange/fellowship [ ] Club Activities
[ ] Academic [ ] Industry [ ] Event invitations
[ ] Community extension/outreach work [ ] Others (please specify):
B. Non-Curricular (Non-Disciplinal)
[✔] Community Outreach [ ] Seminars, trainings or conferences
[ ] Competitions and contests [ ] Event invitations
[ ] Club activities [ ] Others (please specify):

I am granting permission to my son/daughter/ward to attend the said activity in

____________________________________________ on _________________________.
Identify the place/venue of the off-campus activity Dates/period of activity

I assure that my son/daughter/ward shall act responsibly and follow all the university rules and regulations
pertinent to this activity.

I am fully aware that the University of Mindanao shall take all the necessary safety measures and precautions
to keep my son/daughter/ward safe and secure, and shall ensure that all requirements for the said activity are
complied with.

If untoward incidents occur beyond the control of the university, despite all the efforts taken and the exercise
of due diligence effectively established, I waive and release the University of Mindanao, its officers, faculty
and personnel, from liability. Accordingly, I shall fully cooperate with the University of Mindanao for the
resolution of any untoward and uncontrollable events.

I duly affix my signature as stamp of my consent in good faith, without fraud and deceit, as I am fully aware
of my accord and accountability as consenting parent/guardian.

ERNESTO A. PERALTA 08-15-22

___________________________________ ________________
Full name and signature of parent/guardian Date

PROF. AIMEE AYA-AY

Duly checked, verified and signed:
Faculty-in-charge/Head of Office Date
REMINDER: For review and approval by the appropriate level of authority (see back page for guidance)
F-13050-023/ Rev. # 5/ Effectivity: July 19, 2019 Page 1 of 2
 ACADEMIC PLANNING & SERVICES
[ ] Main [ ] Branch
PARENTAL/GUARDIAN CONSENT

Important Reminders

(1) All Deans/Branch Directors/HOOFS need to counter-sign Due Diligence documents including the
parental/guardian consent before submitting for approval to appropriate level of authority.

(2) All off-campus activities requiring financial/funding transactions need approval from the COO/QMR.
The Financial Diligence policy is the reference document for guidelines. This approval of the
COO/QMR for financial/funding transactions shall come after the approval from the appropriate levels
of authority.

(3) Field trips and educational tours under (CMO 63 s. 2017: Checklist Requirements – Checklist A.1
(Before the activity): Checklist A.2 (During the activity): and Checklist A.3 (After the activity). Types
of Reports – Certificate of Compliance (Annex A Template) for all checklists: Report of Compliance
(Annex B Template) for checklists; and Comprehensive Semestral/Term Report (Annex C Template) for
all checklists.

(4) As per CMO 63 s. 2017: Autonomous or deregulated private HEIs and COD/COE/Level II programs are
exempted from submitting Report of Compliance (Annex B) to CHED. They are only required to submit
the Certificate of Compliance (Annex A) and the Comprehensive Report (Annex C) to CHED. The
Annex B requirements shall only be checked. Approved and stored at the HEI level only.

Levels of Approval Authority

A. Curricular (Disciplinal)

(1) Educational tours and field trips – APS

(2) Practicum, internship and OJT – APS
(3) RLE (nursing program) – APS
(4) FS (teacher education programs) – APS
(5) Student exchange/fellowship – ERIAO
(6) Community extension/outreach work – CEC
(7) Research field work/data gathering – College (thesis; capstone); RPC (institutional)
(8) Work immersion (SHS) – APS
(9) Externship – ERIAO
(10) NSTP (CWTS, ROTC, LTS) – CEC
(11) Seminars, trainings and conferences – College (within city); APS (outside city)
(12) Competitions and contests – College (within city); APS (outside city)
(13) Club Activities – OSA
(14) Event invitations – College (within city); APS (outside city)
(15) Others (depends on the nature)

B. Non-Curricular (Non-Disciplinal)

(1) Community Outreach – CEC

(2) Competition and contests – OSA (non-athletics); SDC & Athletics Board (Athletics)
(3) Club Activities – OSA
(4) Seminars, trainings and conferences – OSA
(5) Event invitations – OSA
(6) Others (depends on the nature)

C. Financial Diligence (When Applicable): After approval in A or B. final approval for financial/funding
transaction is COO/QMR.

F-13050-023/ Rev. # 5/ Effectivity: July 19, 2019 Page 2 of 2