MARY’S COLLEGE OF TAGUM, INC

OFFICE OF THE INSTITUTIONAL STUDENT AFFAIRS AND SERVICES

National Highway, Tagum City, 8100 Davao del Norte, Philippines
Email: oisac@smctagum.edu.ph
Quality Transformative Ignacian Marian Education

OISAS -FO- 008

PARENTAL CONSENT FOR OUT-OF-SCHOOL ACTIVITIES

STUDENT INFORMATION:
Student’s Name:
Jangao
Family Name Given Name Middle Name

BSED - English 1 320004

Degree/Major or Section Year/Grade Level I.D. Number

July 06, 2004 19 F Single Roman Catholic

Birthday (mm/dd/yyyy) Age Sex Status Religion
Home Address:
Blk 10 Senanggote 2 Tagum City Davao del Norte
House, Street Barangay City Province
Contact Details:
09518218616 Momo.rochele@smctagum.edu.ph 9100
Mobile Phone Home Phone Email Address Zip Code

I hereby give consent to my son /daughter, Rochele J. Momo, to participate in the

______________________________organized by the _______________________________________________ in
(Title of the Activity/Program) (Sponsoring Program/Club/Organization)

______________________________ on ___________________.
(Destination/venue) (Date(s))

I affirm that, to the best of my knowledge, my child is in good health and fully capable of participating on this
activity. I acknowledge that, despite any medical conditions, such as
_________________________________________, that my child may have, I still provide consent for him/her to
(indicate the condition here if there is any; write N/A if there is none)
engage in any or all of the proposed activities.

Further, I have ensured that my son/daughter understands that it is important for his/her safety and the
safety of the group that he/she obeys any rules and instructions given by the faculty/ adviser/staff in-charge and
follows the Norm of Conduct.

Students must always keep the norm of conduct, consistent with the lgnacian Marian Education
offered by SMCTI. Thus, they are expected to exercise self-discipline, to show courtesy and
consideration to faculty/adviser/staff, fellow students, and members of the public.

Should my son/daughter break this norm of conduct, I agree to support the school's implementation of
appropriate disciplinary action which may include returning the student home at my expense. I understand that while
the staff in charge of the members of the group will take all reasonable care for their health and safety, they cannot
be held responsible, unless they are found to be negligent, for any injury, illness, damage, or loss suffered by my son/
daughter during or arising out of the activity.

I authorize the faculty/ adviser/staff-in-charge of the activity or any school personnel present, to consent to
such medical treatment - including inoculations, surgery, and blood transfusions - which, in the opinion of a qualified
medical practitioner, may be necessary for my child during the activity.

I, therefore, agree to indemnify the St. Mary's College of Tagum, Inc., its employees, and its agents against
all liabilities for injury (including death), illness, loss to person or persons, or damage of property caused by my
son/daughter unless this can be shown to be due to the negligence of the St. Mary's College of Tagum, Inc. or any of
its employees.

I grant permission for photographs and videos of my child taken during the intramural activities to be used
for school-related promotional materials, including the school website, newsletters, and social media without
limitation.
PARENT/GUARDIAN:
Tamodong, Sonny P.

Type of
Given Name, M.I. & Family Name Signature Date and Time Government ID Number
Issued ID
EMERGENCY CONTACT INFORMATION:

Given Name, M.I. & Family Name Mobile Number Home Phone

SUBSCRIBED AND SWORN to before me this _________ day of ________________, 2024 at

_______________________, Philippines. Affiant personally exhibited to me his/her Community Tax Certificate with number
_________________, issue on ___________________and issued at____________________.
Doc. No.: ____________________;
Page No.: ___________________;
Book No.: ___________________;
Series of: ____________________.
Tagum City, Davao del Norte, Philippines Tel. Nos. (084) 216-616-6205; Telefax; (084) 655-9028)

INITIUM SAPIENTIAE TIMOR DOMINI

Faith * Excellence * Service
MARY’S COLLEGE OF TAGUM, INC
OFFICE OF THE INSTITUTIONAL STUDENT AFFAIRS AND SERVICES
National Highway, Tagum City, 8100 Davao del Norte, Philippines
Email: oisac@smctagum.edu.ph
Quality Transformative Ignacian Marian Education
Facebook Page: SMCTI -Office of the Student Affairs and Services

INITIUM SAPIENTIAE TIMOR DOMINI

Faith * Excellence * Service