Valenzuela City | Quezon City | Antipolo City | San Fernando City | Cabanatuan City | Santa Rosa City

COLLEGE OF MEDICAL LABORATORY SCIENCE

COLLEGE OF ENGINEERING

STUDENT & PARENT’S CONSENT FORM

PARTICIPATION IN THE LIMITED FACE-TO-FACE CLASSES

Name: KERBY J. MUNAR

Current Address: BLK 149 LOT 13 SV8B, Brgy. San Isidro Rodriguez
Rizal
Email Address: kjmunar2532qc@student.fatima.edu.ph
Mobile Number: 09394408210
Campus: QUEZON CITY

As a _3rd_ year student of Our Lady of Fatima University - College of Engineering, I have
been oriented and duly informed about the guidelines, requirements, and protocols of the
University for the limited face-to-face classes.

Furthermore, I was allowed by my parent/guardian to join the limited face-to-face activities.

We shall abide by all the health protocols and comply with the requirements which the
University and the local government unit set for the safety of all.

I fully understand that this consent form has been executed for the purpose of my attendance
in the limited face-to-face classes in the campus.

______ Kerby J. Munar_____________ ___01/09/2023____

Student’s Signature over Printed Name Date

_________Charlie J. Munar___________ ____01/09/2023____

Parent’s Signature over Printed Name Date