PARENTAL CONSENT FORM

________________________________________________________
(Name of the College/Campus/Organization)
No.:_____
____
Name of Student: _________________________________ Student Number: _________
Course: _____________________________ Year & Section: ____________________
Name of Activity: ________________________________________________________
Nature of Activity: Seminar/Workshop
Convention
Competition
Others: _________________________

Venue: __________________________________ Inclusive Dates: _________________

To be filled-up by the Parent/Guardian:

I allow my son/daughter to attend the activity.

I trust that the organizers of this activity will take due diligence to ensure the safety of my
son/daughter as a participant. I also agree to absolve the university from legal
responsibility on any untoward incident in the course of the event.

I do not allow my son/daughter to attend the activity.

Name of Parent/Guardian: ____________________________________________________

Phone/Cell phone number(s): _______________________ ______________________

Complete Address: _________________________________________________________

Specimen Signatures: ________________ ________________ ________________

Note:
 This Parental Consent Form must be Accomplished if:
1. the activity is off-campus
2. the activity is overnight or until 9pm
3. the activity falls on a Holiday or Sunday
 This Parental Consent Form must be Notarized (if the activity will be held outside Bulacan)
 Attach a photocopy of the Parent’s/Guardian’s identification card with signature.

BulSU-OP-OSA-04F5 Page 1 of 2
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 PARENTAL CONSENT FORM

 Attach a photocopy of the Parent’s/Guardian’s identification card with signature.

BulSU-OP-OSA-04F5 Page 2 of 2
Revision: 1