Republic of the Philippines PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila) Intramuros, Manila Telefax No. 526-68-82

OFFICE OF THE STUDENT DEVELOPMENT AND SERVICES

COLLEGE :

ACITIVITY :

DATE :

TIME :

VENUE :

REMARKS :

______________________________________________________________________________

PARENTAL CONSENT

We allow our son/daughter _______________________________________________________ with Student Number ____________ from (College) _____________________________ _______ taking up (degree program) _______________________________ join the ___________________________ on ______________________ at _______________________________________.

We voluntarily and knowingly waive all rights of actions against the school, its faculty member/s. employees. officials, and administrators for any injury or damage, as well as costs, expenses and liabilities which may incur during or as a result of the event / field trip. In case of emergency: Name of contact person : ________________________________________________ Relationship : ________________________________________________ Contact Number : ________________________________________________

We dont allow our son / daughter ____________________________ to join the event/fieldtrip.

______________________________________ ____________________________ PARENTS SIGNATURE OVER PRINTED NAME DATE