BOHOL NORTHERN STAR COLLEGE, INC.
BOHOL NORTHEASTERN EDUCATION FOUNDATION
Isaac Garces St., Poblacion, Ubay, Bohol
www.bnsc.edu.ph / boholnorthernstarcollege@bnsc.edu.ph / boholnorthernstarcollege@yahoo.com
OFFICE OF THE STUDENT AFFAIRS AND SERVICES
Student Trip/Travel and/or Participation
The undersigned parent/s/guardian whose printed name/s and signature/s appear below
hereby declare and state:
1. I/we am/are the parent/s/guardian of:
NAME OF STUDENT: _________________________________________________
2. A bona-fide BNSCI student at the college/school of:
NAME OF COLLEGE: ________________________________________________
3. Are aware that said student will be a part of a school/course/class related travel/trip as
follows:
a. Destination:______________________________________________________
b. Purpose:_________________________________________________________
c. Inclusive Dates: __________________________________________________
d. Means of Transportation:___________________________________________
e. Lodging/Board/Accommodation: ____________________________________
f. Monetary Contribution/Expense: ___________________________________
4. I/we understand that the trip/travel/participation is part of the student’s academic
program/course and as such I/we hereby give our permission and consent for said
student to travel as above described and specified.
5. By virtue of this document, I/we unconditionally waive any and all claims or causes of
actions against the Bohol Northern Star College, Inc. (BNSCI), or any of its faculty,
personnel or officials that may arise as a result of said trip/travel/participation such as
accident, fortuitous event, acts of God, any other similar unforeseen event in whatever
nature or form and any loss damage or injury resulting from the fault or act of the
student concerned. This waiver does not however cover intentional acts or negligence;
loss, damage or injury that results therefrom shall be the liability of the person who
intentionally caused the damage, loss or injury.
6. IMPORTANT:
a. If this document is signed by only one parent, please state below the reason why
the other parent’s signature was not obtained. By affixing his/her signature the
signing parent hereby takes full responsibility for this consent/waiver.
___________________________________________________________________________
b. If this document is signed by a guardian, please state below the nature of the
guardianship relation and the legal basis thereof. The guardian or anyone who claims
to act as such takes full responsibility for this consent/waiver.
_____________________________________________________________________
____________________________ ___________________________
PARENT/GUARDIAN PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME)
PERMANENT ADDRESS: ____________________________________________
____________________________________________
CONTACT NUMBER: ____________________________________________
We verified all the information/data herein provided and they are true and
correct to our own personal information and belief.
_________________________ _________________________ _______________________
Dean Department Chair
Faculty/Coordinator
*Please do not alter or modify this document. All information/date required must be
provided correctly and accurately. This document must accompany the letter request at
time the request is submitted.
