ARELLANO UNIVERSITY

Office for Student Affairs

2600 Legarda St., Sampaloc, Manila

Date: ✓

To whom it may concern:

THIS IS TO AUTHORIZE AND GRANT PERMISSION to my son/daughter/dependent: MR/MS.

✓ ,a ✓ (state course and
year/grade level and section) of Arellano University JOSE RIZAL CAMPUS (state the name
of the Department/Institute/Campus), to join and participate on
in MMAU SHS 2023 LOCAL (state
what activity) at AU JRC CENTRAL BUILDING GROUNDS , from MARCH 28, 2023 – 1:00 PM and
to
MARCH 30, 2023 – 1:00 PM (state inclusive time and date of activity).

I HEREBY CERTIFY THAT I have firmly advised my son/daughter/ward to always act with due
diligence, safety, and care, endeavoring at all times to see to it that his/her conduct during the
entire affair/activity shall establish, maintain and contribute to his/her personal security and
protection and those of other participants of the activity.

IN WITNESS WHEREOF, I have hereunto affixed my signature this day of

at the City of .

Parent/Guardian
(Signature over printed name)

SUBSCRIBED AND SWORN to before me this day of in the City of

exhibiting to me his/her .

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