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Parent Concent Form

This document is a parent/guardian consent form from Laguna State Polytechnic University for a student to participate in an off-campus program. It has three parts where the parent gives permission for participation, authorizes emergency medical treatment if they cannot be reached, and agrees to waive liability for any injuries or damages that may occur from participation. The parent signs and dates each section, and the form is notarized.

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francesannejaron19
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79 views1 page

Parent Concent Form

This document is a parent/guardian consent form from Laguna State Polytechnic University for a student to participate in an off-campus program. It has three parts where the parent gives permission for participation, authorizes emergency medical treatment if they cannot be reached, and agrees to waive liability for any injuries or damages that may occur from participation. The parent signs and dates each section, and the form is notarized.

Uploaded by

francesannejaron19
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

Laguna State Polytechnic University


Province of Laguna

PARENT/GUARDIAN CONSENT FORM


College:
Campus: San Pablo City Campus

Name of Student:

Part 1. Permission to Participate


I have understood the information concerning the _______________________ and give my son/daughter,
_____________________________________ (name of student), permission to participate in the said program.
I understand the arrangement for the mobility to the destination. I also understand that my son/daughter must
meet the application requirements to be accepted in the program.

________________________________________ ________________________
Signature of Parent/Guardian over printed name Date

Part 2. Emergency Authorization


In the event that I cannot be reached in an emergency, I give permission to the staff of LSPU or the staff of the
off-campus activity office/unit/agency to secure proper treatment for my son/daughter.

________________________________________ ________________________
Signature of Parent/Guardian over printed name Date

Part 3. Liability
I hereby agree to waive and release any and all rights that I, my child, or our representatives may have to make
claim against LSPU of their respective officers, employees, or representatives arising from injury or damages,
including attorney’s fees, that may result from my child’s participation in the off-campus activity.

I further agree to indemnify and hold harmless the partner/cooperating office/unit/agency or their respective
officers, employees, or representatives from any claims, including attorney’s fees, which I or my child might
make or which might be made on my or our behalf by others, or which might be made against me or my child
by others, arising from my child’s participation in the above-mentioned activity.

________________________________________ ________________________
Signature of Parent/Guardian over printed name Date

SUBSCRIBED AND SWORN TO before me, this ___ day of _____, 2023, exhibiting to me and was identified by me
through his/her competent evidence of identity: _____________________________ issued on _____________
at ____________________.

________________________
Notary Public
until _____________
IBP No. ___________
PTR No. ___________
Doc No. ______
Page No. ______
Book No. ______
Series of 20____

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