ARELLANO UNIVERSITY
Office for Student Affairs
2600 Legarda St., Sampaloc, Manila
Date:___________________
To whom it may concern:
THIS IS TO AUTHORIZE AND GRANT PERMISSION to my son/daughter/dependent: MR/MS.
___________________, a ____________________ (state course and year/grade level and
section) of Arellano University _____________________________ (state the name of the
Department/Institute/Campus), to join and participate in __________________________ (state
what activity) at _______________________, from _____________________ to
______________________ (state inclusive time and date of activity).
I HEREBY CERTIFY THAT I have firmly advised my son/daughter/ward to always act with due
diligence, safety, and care, endeavoring at all times to see to it that his/her conduct during the
entire affair/activity shall establish, maintain and contribute to his/her personal security and
protection and those of other participants of the activity.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of ___________
at the City of _______________.
_________________________
Parent/Guardian
(Signature over printed name)
SUBSCRIBED AND SWORN to before me this ___ day of ____________ in the City of
____________ exhibiting to me his/her ________________________________________.
Doc No. _________
Page No. ________
Book No. ________
Series of ________