PARENT’S PERMIT

I/we hereby grant permission to our daughter/son

______________________________________ to participate in the Educational
Tour/Experiential Learning to be held on ____________________ in ____________________.
I/we fully understand that all the necessary precautions will be taken into consideration to
ensure safety and well-being of my/our child for the duration of the said activity. However, I/we
cannot hold the chaperon/instructor/companion of the school responsible for any incident or
unforeseen circumstances that may happen beyond control.

_________________________________________
Signature over Printed Name of Parent/Guardian

I hereby certify that the signature that appears above is therefore genuine.

__________________________________
Signature over Printed Name of Student

MEDICAL CERTIFICATE
Date _______________
This is to certify that __________________________________________________ years old,
from ___________________________________ came in to this clinic on
___________________.
( ) Physical Examination
( ) Treatment as out-patient
IMPRESSION DIAGNOSIS
REMARKS/DISPOSITION:
( ) Physically and mentally fit/unfit
( ) Advised continuous treatment at home and regular check – up
( ) Advised rest for ____________________
______________________________
Attending Physician

License No. ___________

PTR No. ___________

ACKNOWLEDGEMENT
Republic of the Philippines)
City of Borongan) ss

SUBSCRIBED AND SWORN to me before this ___________ day of ________________ 2023

in _____________________, Philippines.
____________________________________
Person Administering Oath