ADAMSON UNIVERSITY College of Nursing

July 09, 2013 VANESSA B. VARONA, RN, MAN Research and Faculty Development Coordinator

I,

the

undersigned

parent/guardian,

am

fully

aware

that

my

son/daughter

____________________________________ will not be on his/her class at 2:00 pm to 5:00 pm in Research II at ST312 under Professor Vanessa B. Varona, in Adamson University due to data gathering procedure in Research. The school and the Professor will not be held responsible and accountable for any untoward incident that will happen to my son/daughter.

_______________________________ Signature over Printed name Parent/Guardian

_______________________________ Signature over Printed name Student

Contact Information of Parent/Guardian Cellphone No: __________________