- STATEMENT OF PARENTAL CONSENT -

Dear Parents/Guardians:
Your child has expressed his/her intentions of joining the Educational Tour
College of Education Tour
Title of Educational Tour:
AU CoED Day Tour
To Be Held On Place
SEPTEMBER 21, 2018 MANILA, PH
If you are allowing your child to join the said tour, kindly fill-out the Reply Slip below on or before
Deadline of Submission
AUGUST 13, 2018 (NO EXTENSION)
Rest assured that their Facilitator/Adviser will accompany them during the activity. Should there be a need for you to
communicate with your child, kindly call the adviser:
Adviser/ Facilitator's Name Contact Number
KATH CABAUATAN 0997 988 3566 (GLOBE)
OTHER INFORMATION
Assembly Time Assembly Area
4 A.M. PHINMA AU MAIN CAMPUS | BITAS, CAB CITY

Attire Others
DEPARTMENT SHIRT PACKED LUNCH
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PARENT'S/GUARDIAN'S REPLY SLIP
Please be informed that the undersigned poses no objection to the participation of my
Name of Child Year level and Section
child
Title of Educational Tour Place
in the AU CoED Day Tour MANILA, PH
Complete Address

Age Contact Number

Parent/ Guardian's Name Contact Number

MEDICAL INFORMATION/ MEDICAL CLEARANCE

With my child's current medical situation, the undersigned poses no objection to his/her participation
List of the ailments your child suffers from

List any medication your child might need

Indicate any allergies with certain medication

Should my child require medical attention as a result of any accident or any serious illness, I do hereby grant/
bestow upon the organizers of this educational tour permission and authority for and on my behalf to authorize
licensed medical practitioner to render medical aid and treatment.

I hereby give consent for him to take part in the said educational tour.

_______________________________________________
Parent/Guardian's Signature Over Printed Name Date Signed
Students who will not submit their filled-out forms will not be allowed to join the educational tour. The University reserves the
right to withhold participation of a student in school activities.
SUBSCRIBED AND SWORN to before me this __________ day of ___________20_____in the city of Cabanatuan,
Philippines

Book No. _________________ Notary Public

Page No. _________________
Doc. No. _________________
Series No. ________________

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