GENERAL INSTRUCTIONS

Please have this form filled out by your parent or legal guardian and have it notarized by a
lawyer/notary public.

Republic of the Philippines]

C I T Y O F D A V A O ] ss.
**********************
PARENTAL CONSENT FORM

I, _______________________________________, of legal age, Filipino, single, or married (please

check) a resident of ___________________________________________, after having been duly sworn in
accordance with law, hereby depose and say:

1. I am the (please check)

___ Parent
___ Legal Guardian
of ________________________________ based on the records of the University.

2. My child/ward is presently enrolled at the University of Southeastern Philippines this

___ First Semester
___ Second Semester
___ Summer
of SY ___________________;

3. In the course of his/her stay at the University of Southeastern Philippines, he/she will be attending
various school activities, both academic and non-academic and which will bring him/her outside the
campus, such as but not limited to:
a. Sports and Recreational Activities;
b. Research and Extension;
c. Community and Outreach Programs;
d. Field study/On-the-Job Training/Internship;
e. Educational Tours and Field Trips;
f. Clubs and Organizations;
g. ROTC/CWTS related activities;
h. Other school-related activities.

In compliance with CHED Memorandum No. 63, I hereby declare that I am allowing him/her to attend
such activity provided that the same is sanctioned by the University of Southeastern Philippines and provided
further that I am subsequently provided a Parent’s Consent Form per activity which need not anymore be
notarized;

I am executing this affidavit to attest to the veracity of the foregoing facts, in compliance with the
requirements of the Commission on Higher Education, and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________________ at

________________ City, Philippines.

_________________________________
Signature over Printed Name

SUBSCRIBE AND SWORN to before me this _______________________ at __________________,

Philippines, affiant exhibited to me his/her Valid ID ____________________ issued in ______________ City.

Doc. No. __________;

Page No. __________;
Book No. _________;
Series of 2023.
 Republic of the Philippines
University of Southeastern Philippines
Bo. Obrero St., Davao City

Letter to the Parents/Guardian

Dear Parents or Guardian,
______________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________.

Off Campus Activity Information:

Goal: ____________________________________________________________________________________
Objectives: _______________________________________________________________________________
Activities: ________________________________________________________________________________
Date: ____________________________________________________________________________________
Destination: ______________________________________________________________________________
Cost and Breakdown: _______________________________________________________________________
Mode of Payment: _________________________________________________________________________
Route: ___________________________________________________________________________________
Departure Time from USeP: __________________________________________________________________
Recommendation (If Necessary): Medical Certificate ______________________________________________

Respectfully yours,

______________________
Subject Teacher

____________________________________________________________________________________

Parental Consent Agreement

I/We, __________________________________ allow my son/daughter ____________________________ to

participate in the __________________________________ which requires transportation away from the University
of Southeastern Philippines (USeP) ______________ campus. I/We am/are aware that the activity will be under the
guidance and direction of Mr./Ms. __________________________________ faculty/adviser of the College of
____________________________________.

As parent (s) /guardian (s), I/We acknowledge that Mr./Ms. ________________________________, subject
teacher/adviser of ___________________________ provided me/us with necessary information pertaining to the
planned activity, duration, location, participants and supervision.

I/We am/are aware that there are inherent risks of injury to participate in this activity outside the school.
These injuries may be minor or serious and may result from one’s actions, or the actions or inaction of others, or a
combination of both.

I/We have read and understood the rules and guidelines for activities outside USeP activities and thereby
agree to the conditions set for the safety and protection of my son/daughter. I/We shall inform my son/daughter
to abide by the guidelines crafted by USeP.

I/We declare having read and understood the above Parental Consent Agreement in its entirely and hereby
consent to allow my/our child to participate, acknowledging all of the foregoing.

________________________________ _______________
Parent/Guardian Signature Date