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Parental Consent Retreat 2024

This document is a parental consent form for a retreat program at the Dominican House of Prayer in Tagaytay City, scheduled from May 13 to May 15, 2024. It acknowledges the benefits and risks associated with the activity and grants permission for emergency medical treatment if necessary. The form also includes sections for emergency contact information and student acknowledgment of the school's conduct policies during the trip.

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Eldin Tolentino
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59 views2 pages

Parental Consent Retreat 2024

This document is a parental consent form for a retreat program at the Dominican House of Prayer in Tagaytay City, scheduled from May 13 to May 15, 2024. It acknowledges the benefits and risks associated with the activity and grants permission for emergency medical treatment if necessary. The form also includes sections for emergency contact information and student acknowledgment of the school's conduct policies during the trip.

Uploaded by

Eldin Tolentino
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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IDENTITY, FORMATION AND MISSION

DIVISION
OFFICE FOR CAMPUS MINISTRY
PARENTAL CONSENT
F – PC-OFCM-001-V1-2023-01-24

I hereby willingly and voluntarily give my child, ________________________________________


(Name) enrolled in BSCPE 4, BSECE 4, BSIE 4, BSFM 4, BSHM 4, HRDM 4 to participate
in the activity/program describe below:

Destination : Purpose :
DOMINICAN HOUSE RETREAT
OF PRAYER TAGAYTAY
CITY
Place of Departure Date of Departure Time of Departure
SSCR-DC MAIN CAMPUS May 13, 2024 7:30 AM
Place of Return Date of Return Expected Return Time
SSCR-DC MAIN CAMPUS May 15, 2024 9:30 AM
Notes:

I acknowledge the benefits and relevance of the activity/program to the course/grade and
the risks that cannot be eliminated during the actual date(s).
I further grant permission for my son/daughter to receive emergency medical treatment in
such case beyond control of the school and notify with the Emergency Contact Information.

EMERGENCY CONTACT INFORMATION


Name Relationship to Child
Contact Information ID Information(please provide photocopy)

_________________________________________________ __________________
Printed Name over Signature of Parent/Guardian
Date
I am aware that when I am on travel, I am under the jurisdiction and supervision of the school’s PIC (Personnel In-
charge) and that my behavior must conform to the Code of Student Conduct, the school's Student Handbook, and
reasonable instructions from PIC. I understand I will be subject to appropriate disciplinary action for violations of
these rules and regulations.
___________________________________ ____________________
_______________________
Signature of Student Date Contact
Information
Republic of the Philippines)
Cavite City ) s.s.
SUBSCRIBED AND SWORN TO before me this ____ day of ________________, 2024 at Cavite City.
Doc. No. ______
Page No. ______
Book No. ______

Page 1 of 2
Manila-Cavite Road Sta. Cruz, Cavite City (046)431-7011 www.sscr.edu
IDENTITY, FORMATION AND MISSION
DIVISION
OFFICE FOR CAMPUS MINISTRY
PARENTAL CONSENT
Series of 2024 F – PC-OFCM-001-V1-2023-01-24

Page 2 of 2
Manila-Cavite Road Sta. Cruz, Cavite City (046)431-7011 www.sscr.edu

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