IDENTITY, FORMATION AND MISSION DIVISION

CENTER FOR RECOLETOS COMMUNITY OUTREACH PROGRAM

PARENTAL CONSENT
F – PC-CReCOP-001-V1-2023-01-24

I hereby willingly and voluntarily give my child, ______________________________ (Name) enrolled

in __________________ (Course/Grade) to participate in the activity/program describe below:

Destination Purpose
Place of Departure Date of Departure Time of Departure

Place of Return Date of Return Expected Return Time

Notes

I acknowledge the benefits and relevance of the activity/program to the course/grade and the
risks that cannot be eliminated during the actual date(s).
I further grant permission for my son/daughter to receive emergency medical treatment in such
case beyond control of the school and notify with the Emergency Contact Information.

EMERGENCY CONTACT INFORMATION

Name Relationship to Child
Contact Information ID Information(please provide photocopy)

_________________________________________________ __________________
Printed Name over Signature of Parent/Guardian Date
I am aware that when I am on travel, I am under the jurisdiction and supervision of the school’s PIC (Personnel In-charge)
and that my behavior must conform to the Code of Student Conduct, the school's Student Handbook, and reasonable
instructions from PIC. I understand I will be subject to appropriate disciplinary action for violations of these rules and
regulations.
___________________________________ ____________________ _______________________
Signature of Student Date Contact Information
Republic of the Philippines)
Cavite City ) s.s.
SUBSCRIBED AND SWORN TO before me this ____ day of ________________, 2023 at Cavite City.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2023

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Manila-Cavite Road Sta. Cruz, Cavite City (046)431-7011 www.sscr.edu