UNIVERSITY OF SOUTHERN MINDANAO

Kabacan, Cotabato
Philippines
PARENT’S/GUARDIAN’S ACKNOWLEDGEMENT

I / We, the parent(s) / guardian of ________________________________, a

___________ of the Department of ______________________, College
of__________________, hereby acknowledge that I am / we are fully aware that the required
________________ to be undertaken by my/our son/daughter/ward is an integral part of the
academic work leading to the completion of his/her program leading to the degree of Bachelor
of _____________________________ offered by the College.

Furthermore, I / we acknowledge the following:

That every co-curricular activity that my son/daughter/ward participates in involves risk

or risks which are beyond the control of the College / University;

That I / we fully believe that the management of the College / University leaves no
unturned stone to promote and safeguard the welfare and safety of my/our
son/daughter/ward, most especially during off-campus co-curricular activities, like this
_____________________ and;

That in case of any untoward incident that may possibly happen during the conduct of
the ______________________ due to circumstances beyond the control of the
_______________ or faculty adviser/supervisor/coach/chaperone(s), in particular and the
University, in general, I/we shall not hold them liable nor file a complaint against them.

_________________________
Signature over Printed
Name PARENT/GUARDIAN

SUBSCRIBED and SWORN to before this ____day of _______ 20___, with the affiant
exhibiting to me his/her Community Tax Certificate No._____, issued on _________________at
_____________________.

Doc No. __________

Page No. __________ NOTARY PUBLIC
Book No. __________
Series No. __________

USM-DIO-F17-Rev.0.2022.12.07