Republic of the Philippines)

City of ________________) S.S.

AFFIDAVIT

I, ______________________________________ (Parent’s / Guardian’s Name), Filipino, of legal

age, and a resident of ____________________________________, Philippines, after having been duly
sworn to in accordance with law, hereby depose and state that:
1. I am the father/mother/guardian of __________________________________________________
(Student’s name), a student of the College/Department of ___________________________ of the
University of Cebu;
2. My son/daughter/ward intends to participate in the activity described as follows:

Name of Activity

Date and Time

Venue

Organizer/s

3. I am giving my full consent to my said son/daughter in his/her participation to the above

mentioned activity;
4. I am executing this affidavit to attest to the truth of the foregoing statements.

IN WITNESS WHEREOF, I set my hand this _________________ (Date signed) at __________

(Place signed), Philippines.

_________________________________________ _______________________________________
Parent’s Signature over Printed Name Student’s Signature over Printed Name
Valid Government ID No. ___________________ School ID No. ___________________________
(Please attach photocopy of valid government ID) (Please attach photocopy of school ID)

Noted by:
__________________________________________________________
Adviser’s/ Dean’s/ Department Head’s Signature over Printed Name
Valid Government ID No. _________________________________
(Please attach photocopy of valid government ID)

SUBSCRIBED AND SWORN to before me on the date and place above written, affiants
exhibiting to me their competent evidence of identity.

Doc. No. _________;

Page No. _________;
Book No. ________; NOTARY PUBLIC
Series of _________;

NOTE: Reproduce at least three (3) copies of this Affidavit and affix original signature on each copy.