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 : _College of Engineering and Technology__________________________

ACITIVITY & PURPOSE:________________________________ __________________________
DATE : __________________________________________________________
TIME :___________________________________________________________
VENUE :___________________________________ ________________________
POINT PERSON :___________________________________________________________
______________________________________________________________________________

PARENTAL CONSENT

We allow our son/daughter _ _______________________________________

with student number _ _____________ from (college) College of Engineering and Technology_
taking up (degree program) ______________Bachelor of Science Chemical Engineering_________to join
the _______________________________________________ on _______________________ _______
at _______________________________________________.

We voluntarily and knowingly waive all rights and causes of actions against the school, its
faculty member/s, employees, officials, and administrators except for liabilities arising from
injuries and damages caused by gross negligence on the part of the University.

Monetary contribution/donation ____________________________________________

(Write in words)

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

Note: Not valid without the photocopied parents identification card.