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Parental Consent With Notary

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133 views1 page

Parental Consent With Notary

Uploaded by

Jonathan Acosta
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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ILOCOS SUR POLYTECHNIC STATE COLLEGE Document No.

ISPSC-QAD-F032a
Revision No. 1
COMMUNICATION Effectivity Date: March 2022
(Internal) Page No. 1 of 1

Date

PARENTAL CONSENT

I/We hereby willingly and voluntarily give consent to the participation of my/our

son/daughter to the
(Name of Student)
on at
(Name of Program/Activity) (Date)
.
(Venue)

I/We have considered the benefits that my son/daughter will derive from his/her participation
in the activity provided that due care, diligence and necessary precautions will be observed. It is
understood also that my son/daughter will follow the policies and guidelines set by the College and
abide by the rules and regulations that may be imposed by the Personnel- in-charge before and during
the activity for his/her safety and welfare.

Further, I/We authorize the personnel of the Ilocos Sur Polytechnic State College to collect,
process, retain and dispose of personal information of our son/daughter in accordance with the Data
Privacy Act of 2012.

Signature of Parent/Guardian Over Printed Name


Contact No.:
Verified:

Personnel-In-Charge Program Head/College Dean


(Signature Over Printed Name) (Signature Over Printed Name)

Remarks:

SUBSCRIBED AND SWORN to before me this day of ___________, at


__________________________, affiant presenting to me his/her validly government issued identification
card ________________________ with no. _____________________.

_______________________________________
(Person Administering Oath)

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