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013 Parents or Guardians Permit Form
013 Parents or Guardians Permit Form
Tacloban City
OFFICE OF THE VICE PRESIDENT FOR
STUDENT DEVELOPMENT AND AUXILIARY SERVICES
vpsdas@lnu.edu.ph
053 888 0855 local 260
______Semester,
SY_______
PLEASE TAKE NOTE OF THE FOLLOWING:
1. Please fill out this form in BLOCK LETTERS and in triplicate.
2. ALL sections MUST BE FILLED OUT COMPLETELY.
3. Permits for Educational Tour/Field Trip purposes and for a participant who is a minor should be notarized.
4. If the student involved is a MINOR, BOTH parents MUST sign the permission form.
1. ________________________________________ ____________________________________
2. ________________________________________ ____________________________________
3. ________________________________________ ____________________________________
4. ________________________________________ ____________________________________
5. ________________________________________ ____________________________________
Further, I/we fully understand that I/we cannot hold the university administrators and instructors liable for any unforeseen/untoward
incidents beyond our control.
IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this ______________________in ______________________________,
(Date) (Place)
Philippines.
________________________________________ ________________________________________
Name and Signature of Parent/Guardian #1 Name and Signature of Parent/Guardian #2
________________________________________ ________________________________________
Complete Address Complete Address
________________________________________ ________________________________________
Contact Number Contact Number
________________________________________ ________________________________________
ID Type & Number ID Type & Number
J U R A T
F-SDM-013 (09-02-19)_______________________________________________________________________________