PARENTS CONSENT AND WAIVER:

Student Trip/Travel and Participation

The undersigned parents/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 MMSU student at the college/school of:
NAME OF COLLEGE:
COLLEGE OF ENGINEERING
3. Are aware that said student will be a part of a school/course/class
related travel/trip as follows:
a. Destination: CAAP LAOAG, INTERNATIONAL AIRPORT, LAOAG CITY
b. Purpose: TO UNDERGO A NAVIGATIONAL FACILITY VISIT
c. Inclusive dates:
AUGUST 28,2015
d. Means of transportation: MMSU VEHICLE
e. Lodging/board/accommodation: N/A
f. Monetary Contribution/Expense: Php 45.46 per student
4. I/we hereby give our permission and consent for said student to travel
as above described and specified
5. I/we hereby unconditionally waive any and all claims or causes of
actions that may arise as a result of said trip/travel/participation, such
as accident, negligence and similar unforeseen events and acts of God,
including intentional acts, in whatever nature or form, in favor the
Mariano Marcos State University (MMSU). This waiver shall also apply
to any official member of the trip, travel or delegation except when the
loss or injury, claim or cause of action results from an intentional act or
omission, in which case the latter shall be personally held liable for any
and all criminal, civil and/or administrative violation, if any.
6. I/we are fully aware and understand that this consent/waiver is an
indispensable condition to the participation of said student.
7. If this consent/waiver is signed by only one parent, the signing
parent hereby takes full responsibility for any all consequences of this
consent/waiver. Please state below the reason why the other parents
signature was not obtained.
8. If this consent/waiver is signed by a guardian, the latter takes full
responsibility for any and all consequences of this consent/waiver.
Please state below the nature of the guardianship relation and the
legal basis therefore.

PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

EMILIA D. AGULLANA
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

PERMANENT ADDRESS:
CONTACT NUMBER:
MMSU Student Permit to Travel

PARENTS CONSENT AND WAIVER:

Student Trip/Travel and Participation
The undersigned parents/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: RACHELE T. BRENDEZ
2. A bona-fide MMSU student at the college/school of:
NAME OF COLLEGE:
COLLEGE OF ENGINEERING
3. Are aware that said student will be a part of a school/course/class
related travel/trip as follows:
a. Destination: SMX CONVENTION CENTER, SM AURA PREMIER,
TAGUIG CITY

4.

b. Purpose: TO ATTEND THE 64TH IECEP AGM & NATIONAL

CONVENTION
c. Inclusive dates:
NOVEMBER 19, 2014
d. Means of transportation: MMSU VEHICLE
e. Lodging/board/accommodation:
f. Monetary Contribution/Expense: COE-SDF
I/we hereby give our permission and consent for said student to travel
as above described and specified
I/we hereby unconditionally waive any and all claims or causes of
actions that may arise as a result of said trip/travel/participation, such
as accident, negligence and similar unforeseen events and acts of God,
including intentional acts, in whatever nature or form, in favor the
Mariano Marcos State University (MMSU). This waiver shall also apply
to any official member of the trip, travel or delegation except when the
loss or injury, claim or cause of action results from an intentional act or
omission, in which case the latter shall be personally held liable for any
and all criminal, civil and/or administrative violation, if any.
I/we are fully aware and understand that this consent/waiver is an
indispensable condition to the participation of said student.
If this consent/waiver is signed by only one parent, the signing
parent hereby takes full responsibility for any all consequences of this
consent/waiver. Please state below the reason why the other parents
signature was not obtained.

5.

6.
7.

8. If this consent/waiver is signed by a guardian, the latter takes full

responsibility for any and all consequences of this consent/waiver.
Please state below the nature of the guardianship relation and the
legal basis therefore.

ELMO C. BRENDEZ
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

ROSALINA T. BRENDEZ
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

PERMANENT ADDRESS: BRGY. JUAN, SOLSONA, ILOCOS NORTE 2910

CONTACT NUMBER: 09089367143
MMSU Student Permit to Travel

PARENTS CONSENT AND WAIVER:

Student Trip/Travel and Participation
The undersigned parents/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: JAMES GERALD C. DUMBRIQUE
2. A bona-fide MMSU student at the college/school of:
NAME OF COLLEGE:
COLLEGE OF ENGINEERING
3. Are aware that said student will be a part of a school/course/class
related travel/trip as follows:
a. Destination: SMX CONVENTION CENTER, SM AURA PREMIER,
TAGUIG CITY

4.

b. Purpose: TO ATTEND THE 64TH IECEP AGM & NATIONAL

CONVENTION
c. Inclusive dates:
NOVEMBER 19, 2014
d. Means of transportation: MMSU VEHICLE
e. Lodging/board/accommodation:
f. Monetary Contribution/Expense: COE-SDF
I/we hereby give our permission and consent for said student to travel
as above described and specified
I/we hereby unconditionally waive any and all claims or causes of
actions that may arise as a result of said trip/travel/participation, such
as accident, negligence and similar unforeseen events and acts of God,
including intentional acts, in whatever nature or form, in favor the
Mariano Marcos State University (MMSU). This waiver shall also apply
to any official member of the trip, travel or delegation except when the
loss or injury, claim or cause of action results from an intentional act or
omission, in which case the latter shall be personally held liable for any
and all criminal, civil and/or administrative violation, if any.
I/we are fully aware and understand that this consent/waiver is an
indispensable condition to the participation of said student.
If this consent/waiver is signed by only one parent, the signing
parent hereby takes full responsibility for any all consequences of this
consent/waiver. Please state below the reason why the other parents
signature was not obtained.

5.

6.
7.

8. If this consent/waiver is signed by a guardian, the latter takes full

responsibility for any and all consequences of this consent/waiver.
Please state below the nature of the guardianship relation and the
legal basis therefore.

ROGELIO J. DUMBRIQUE
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

JOSEPHINE C. DUMBRIQUE
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

PERMANENT ADDRESS: BRGY. 47 BENGCAG, LAOAG CITY,

NORTE 2900

ILOCOS

CONTACT NUMBER: 09202431234 / 09194850182

MMSU Student Permit to Travel

PARENTS CONSENT AND WAIVER:

Student Trip/Travel and Participation
The undersigned parents/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: CZAR JHAY M. HERNANDO
2. A bona-fide MMSU student at the college/school of:
NAME OF COLLEGE:
COLLEGE OF ENGINEERING
3. Are aware that said student will be a part of a school/course/class
related travel/trip as follows:
a. Destination: SMX CONVENTION CENTER, SM AURA PREMIER,
TAGUIG CITY

4.

b. Purpose: TO ATTEND THE 64TH IECEP AGM & NATIONAL

CONVENTION
c. Inclusive dates:
NOVEMBER 19, 2014
d. Means of transportation: MMSU VEHICLE
e. Lodging/board/accommodation:
f. Monetary Contribution/Expense: COE-SDF
I/we hereby give our permission and consent for said student to travel
as above described and specified
I/we hereby unconditionally waive any and all claims or causes of
actions that may arise as a result of said trip/travel/participation, such
as accident, negligence and similar unforeseen events and acts of God,
including intentional acts, in whatever nature or form, in favor the
Mariano Marcos State University (MMSU). This waiver shall also apply
to any official member of the trip, travel or delegation except when the
loss or injury, claim or cause of action results from an intentional act or
omission, in which case the latter shall be personally held liable for any
and all criminal, civil and/or administrative violation, if any.
I/we are fully aware and understand that this consent/waiver is an
indispensable condition to the participation of said student.
If this consent/waiver is signed by only one parent, the signing
parent hereby takes full responsibility for any all consequences of this
consent/waiver. Please state below the reason why the other parents
signature was not obtained.

5.

6.
7.

8. If this consent/waiver is signed by a guardian, the latter takes full

responsibility for any and all consequences of this consent/waiver.
Please state below the nature of the guardianship relation and the
legal basis therefore.

ROMEO D. HERNANDO
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

LORNA M. HERNANDO
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

PERMANENT ADDRESS: BRGY. 6 SAN PEDRO,

NORTE 2916

BACARRA,

ILOCOS

CONTACT NUMBER: 09984297362

MMSU Student Permit to Travel

PARENTS CONSENT AND WAIVER:

Student Trip/Travel and Participation
The undersigned parents/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: ERIC VICTOR S. LEYSAN
2. A bona-fide MMSU student at the college/school of:
NAME OF COLLEGE:
COLLEGE OF ENGINEERING
3. Are aware that said student will be a part of a school/course/class
related travel/trip as follows:
a. Destination: SMX CONVENTION CENTER, SM AURA PREMIER,
TAGUIG CITY

4.

b. Purpose: TO ATTEND THE 64TH IECEP AGM & NATIONAL

CONVENTION
c. Inclusive dates:
NOVEMBER 19, 2014
d. Means of transportation: MMSU VEHICLE
e. Lodging/board/accommodation:
f. Monetary Contribution/Expense: COE-SDF
I/we hereby give our permission and consent for said student to travel
as above described and specified
I/we hereby unconditionally waive any and all claims or causes of
actions that may arise as a result of said trip/travel/participation, such
as accident, negligence and similar unforeseen events and acts of God,
including intentional acts, in whatever nature or form, in favor the
Mariano Marcos State University (MMSU). This waiver shall also apply
to any official member of the trip, travel or delegation except when the
loss or injury, claim or cause of action results from an intentional act or
omission, in which case the latter shall be personally held liable for any
and all criminal, civil and/or administrative violation, if any.
I/we are fully aware and understand that this consent/waiver is an
indispensable condition to the participation of said student.
If this consent/waiver is signed by only one parent, the signing
parent hereby takes full responsibility for any all consequences of this
consent/waiver. Please state below the reason why the other parents
signature was not obtained.

5.

6.
7.

8. If this consent/waiver is signed by a guardian, the latter takes full

responsibility for any and all consequences of this consent/waiver.
Please state below the nature of the guardianship relation and the
legal basis therefore.

EDWARD U. LEYSAN
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

ESTRELLA S. LEYSAN
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

PERMANENT ADDRESS: BRGY. DARDARAT, CABUGAO, ILOCOS SUR

CONTACT NUMBER: 09154639964 / 09273698577
MMSU Student Permit to Travel

PARENTS CONSENT AND WAIVER:

Student Trip/Travel and Participation
The undersigned parents/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: ALVIN JAY S. MENOR
2. A bona-fide MMSU student at the college/school of:
NAME OF COLLEGE:
COLLEGE OF ENGINEERING
3. Are aware that said student will be a part of a school/course/class
related travel/trip as follows:
a. Destination: SMX CONVENTION CENTER, SM AURA PREMIER,
TAGUIG CITY

4.

b. Purpose: TO ATTEND THE 64TH IECEP AGM & NATIONAL

CONVENTION
c. Inclusive dates:
NOVEMBER 19, 2014
d. Means of transportation: MMSU VEHICLE
e. Lodging/board/accommodation:
f. Monetary Contribution/Expense: COE-SDF
I/we hereby give our permission and consent for said student to travel
as above described and specified
I/we hereby unconditionally waive any and all claims or causes of
actions that may arise as a result of said trip/travel/participation, such
as accident, negligence and similar unforeseen events and acts of God,
including intentional acts, in whatever nature or form, in favor the
Mariano Marcos State University (MMSU). This waiver shall also apply
to any official member of the trip, travel or delegation except when the
loss or injury, claim or cause of action results from an intentional act or
omission, in which case the latter shall be personally held liable for any
and all criminal, civil and/or administrative violation, if any.
I/we are fully aware and understand that this consent/waiver is an
indispensable condition to the participation of said student.
If this consent/waiver is signed by only one parent, the signing
parent hereby takes full responsibility for any all consequences of this
consent/waiver. Please state below the reason why the other parents
signature was not obtained.

5.

6.
7.

8. If this consent/waiver is signed by a guardian, the latter takes full

responsibility for any and all consequences of this consent/waiver.
Please state below the nature of the guardianship relation and the
legal basis therefore.

ALEX A. MENOR
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

EVA S. MENOR
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

PERMANENT ADDRESS: BRGY. LANGAGAN, SANCHEZ MIRA, CAGAYAN

CONTACT NUMBER: 09154639964 / 09063235288
MMSU Student Permit to Travel

PARENTS CONSENT AND WAIVER:

Student Trip/Travel and Participation
The undersigned parents/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: IAN U. URMENETA
2. A bona-fide MMSU student at the college/school of:
NAME OF COLLEGE:
COLLEGE OF ENGINEERING
3. Are aware that said student will be a part of a school/course/class
related travel/trip as follows:
a. Destination: SMX CONVENTION CENTER, SM AURA PREMIER,
TAGUIG CITY

4.

b. Purpose: TO ATTEND THE 64TH IECEP AGM & NATIONAL

CONVENTION
c. Inclusive dates:
NOVEMBER 19, 2014
d. Means of transportation: MMSU VEHICLE
e. Lodging/board/accommodation:
f. Monetary Contribution/Expense: COE-SDF
I/we hereby give our permission and consent for said student to travel
as above described and specified
I/we hereby unconditionally waive any and all claims or causes of
actions that may arise as a result of said trip/travel/participation, such
as accident, negligence and similar unforeseen events and acts of God,
including intentional acts, in whatever nature or form, in favor the
Mariano Marcos State University (MMSU). This waiver shall also apply
to any official member of the trip, travel or delegation except when the
loss or injury, claim or cause of action results from an intentional act or
omission, in which case the latter shall be personally held liable for any
and all criminal, civil and/or administrative violation, if any.
I/we are fully aware and understand that this consent/waiver is an
indispensable condition to the participation of said student.
If this consent/waiver is signed by only one parent, the signing
parent hereby takes full responsibility for any all consequences of this
consent/waiver. Please state below the reason why the other parents
signature was not obtained.

5.

6.
7.

8. If this consent/waiver is signed by a guardian, the latter takes full

responsibility for any and all consequences of this consent/waiver.
Please state below the nature of the guardianship relation and the
legal basis therefore.

REYNALDO U. URMENETA
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

GRACIA U. URMENETA
PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME)

PERMANENT ADDRESS: BRGY. BARBARIT, MAGSINGAL, ILOCOS SUR

CONTACT NUMBER: 09064172108 / 09265135396
MMSU Student Permit to Travel