University of Perpetual Help System Laguna

City of Biñan, Laguna, Philippines, 4024

(+632)779-5310 • 544-5150 • 544-5161
www.uphsl.edu.ph

PARENTAL CONSENT FOR

LIMITED FACE-TO-FACE CLASSES

NAME OF STUDENT: _________________________________________________________________

PROGRAM OF STUDY:

________________________________________________________________

PARENT’S/GUARDIAN’S NAME: _______________________________________________________

HOME ADDRESS: ____________________________________________________________________

I, ___________________________________, parent/guardian of
________________________________, grant permission for my child/ward to participate in face-to-face
classes in core and professional courses.

As a parent/guardian, I am aware:

1. of the University of Perpetual Help System Laguna Policies, Procedures and Guidelines (PPG)
for limited face-to-face classes in core and professional courses;
2. that laboratory knowledge, methodologies are best acquired and simulated in the laboratory itself;
3. that University of Perpetual Help System Laguna has ensured that classrooms, laboratories and
other school facilities are retrofitted and that all their policies and procedures are in accordance
with CHED and IATF regulations as regards the emergence of diseases;
4. that University of Perpetual Help System Laguna has endeavored to ensure maintenance of a
healthy learning environment;
5. that I shall be one with the University of Perpetual Help System Laguna in monitoring my
child’s/ward’s academic progress and medical condition.

Finally, for any concern with my child/ward while in the University, I may be reached through this
contact number/email address: ______________________________________.

_______________________________________
Signature over printed name of Parent/Guardian

* Please attach signed photocopy of a valid ID

SUBSCRIBED AND SWORN to before me this _______ day of ___________________, in the

______________________________, Philippines, by the above-named Affiant who is identified by me
through a competent evidence of (his/her) identify. I further certify that the foregoing document was
signed in my presence and that I have personally examined the Affiant and I am convinced that (he/she)
understood (his/her) statements as (his/her) free act and voluntary deed.

Doc. No.: ________:

Page No.: ________:
Book No.: ________:
Series of 2022