Republic of the Philippines

CATANDUANES STATE UNIVERSITY

Virac, Catanduanes

National Service Training Program

PARENT’S/GUARDIAN’S PERMISSION AND WAIVER

I, __________________________________________do hereby grant permission to my

(Name of Parent and Guardian)
son/daughter ______________________________________ to attend the
International Coastal Cleanup 2022 on September 17, 2022, at the
_______________________________________.
(Venue of Event)

It is understood, however, that precautionary measures shall always be considered to

ensure safety. Should any untoward incident happen beyond human control, I hereby waive my
right for civil, and criminal actions, or otherwise against the Catanduanes State University and
any of its officials.

Done this _________ day of _________________, 20____ at the Catanduanes State

University, Virac, Catanduanes.

____________________________________ _____________________________________
(Signature Over Printed Name of Student) (Signature Over Printed Name of Parent/Guardian)

NOTED:

EMLYN M. LANON
NSTP/NSRC Director

CSU-F-ACAD-25 Rev. 0 Effectivity Date: June 1, 2015