Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND

Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
PARENTAL CONSENT FOR LIMITED FACE-TO-FACE

I, _________________CECILIA E. SABLAYAN_______________, hereby give my permission

(PARENT/GUARDIAN)
in favor of JUVI_LEE E. SABLAYAN who is my ______________DAUGTHER___________________

(STUDENT) (Relationship to Student)

to attend Related Learning Experience and other related activities on limited face-to-face set-up.

I further declare that I fully understand that he/she has to comply with the following
requirements/obligations in relation to his/her attendance therein:

a) to comply with all the requirements as maybe prescribed by the DOH, IATF, LGU, CHED
and NEUST relevant thereto;
b) to truthfully fill-out all the questions on daily triaging and the NEUST-College of Nursing
Covid-19 Declaration using Google form every time they enter the university;
c) to use appropriate protective gears face mask, face shield, and bring their own personal
hygiene kits;
d) to strictly observe the 1.5 meters physical distancing and avoid prolonged face to face
interaction between and among students;
e) to be a PhilHealth member or a beneficiary of a PhilHealth member;
f) to comply with all the guidelines and policies provided by the NEUST-College of Nursing
and the university; and
g) to achieve nursing competencies/course outcomes for professional nursing course as
specified in CMO 15, s. 2017.

I also fully understand the consequences and risks that my child will encounter in limited face-
to-face set-up and I hereby declare that I am giving my consent freely and voluntarily in his/her favor. I
likewise understand that any violation or non-compliance of the above-enumerated requirements
obligations would disqualify him/her to participate in the Related Learning Experience on limited face-to-
face set-up

IN WITNESS WHEREOF, I hereby affix my signature this _________________, hereat

_______________________.
______________Cecilia E. Sablayan________
Parent/Guardian Name & Signature
ID No. _________________________________

Juvi_Lee E. Sablayan
Student Name & Signature
ID No. _________________________________

SUBSCRIBED AND SWORN to before me this ___________________ hereat

____________________. Affiant exhibited to me her Identification Card written below his/her name and
signature.
Doc No. ______
Page No. _____
Book No. _____
Series of ______

Note: This form must be completed and signed by a Parent or Guardian duly notarized by a Notary Public
and shall be returned to NEUST-College of Nursing before the student will be allowed to participate in
the Related Learning Experience on limited face-to-face set-up.

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