Republic of the Philippines
BULACAN STATE UNIVERSITY
City of Malolos, Bulacan
(W rite the name of College/Campus /Organization)
PARENTAL CONSENT FORM No.:____
___
Name of Student: ____________________________________ Student Number: __________
Course: _______________________________ Year & Section: ______________________
Name of Activity: ____________________________________________________________
Nature of Activity: Seminar/Workshop
Convention
Competition
Others: _________________________
Venue: ______________________________________ Inclusive Dates: _________________
To be filled-up by the Parent/Guardian:
I allow my son/daughter to attend the activity.
I trust that the organizers of this activity will take due diligence to ensure the safety
of my son/daughter as a participant. I also agree to absolve the university from
legal responsibility on any untoward incident in the course of the event.
I do not allow my son/daughter to attend the activity.
Name of Parent/Guardian: __________________________________________________
Phone/Cell phone number(s): ______________________ ______________________
Complete Address: ________________________________________________________
Specimen Signatures: _______________ _______________ ________________
Note:
This Parental Consent Form must be Notarized (if the activity will be held outside Bulacan)
Attach a photocopy of the Parents/Guardians identification card with signature.