PARENTAL CONSENT
I, hereby grant the permission for my son/daughter
a student of Jose Maria College to participate in the event/s
described below which requires transportation to a location away from the school site. This
activity will take place under the guidance and direction of the personnel-in-charge
_________________________________________.
Name of the Subject/Event: _____________________
Location of the event: _____________________
Date of the event: _____________________
Departure time: _____________________
Return date/ time: ____________________
Mode of the transportation_____________________
Cost of the Activity:___________________________
As parent and/or legal guardian, I will remain legally responsible for any personal
action/s taken by the above-named participant. While attending the event or in connection with
any illness or injury or cost of medical treatment in connection therewith. In signing the Parental
Consent, I am not relying on any oral or written representation or statements made by the
school and, its officers, directors and agents, employees, faculty, or representatives associate
with the event, to induce me to permit my
student/_______________________________________ to take the trip, other than those set
out in this consent. Further, I have read and understand the terms of this consent, and
recognized that it is binding upon me, my heirs, executors and administrator.
Signature of Parent/Guardian over Printed Name
Home Address:
Contact No.
CTC or GSIS/SSS ID No.__ ___________________
EDate of Issue: ______________________________
Place of Issue: __ ___________________________
ACKNOWLEDGEMENT
3
REPUBLIC OF THE PHILIPPINES)
City of Day ) S.S
x--------------------------------------------x)
BEFORE ME, a Notary Public for and in the City of Davao, Philippines, personally
appeared the parties with their Community Tax Number written above, below their names
known to me to be the same persons who executed the foregoing instruments and they
acknowledged that the same is their free act and voluntary deed.
______________________________________
Notary Public
Doc. No.___________
Page No.___________
Book No.___________
Series of ___________