REPUBLIC OF THE PHILIPPINES)

Midsayap, North Cotabato) s.s.

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AFFIDAVIT of CONSENT

I, _____________________________, of legal age, Filipino, and a resident of

____________________________________, after having been duly sworn to in
accordance with law, hereby deposed and say:

1) I am the parent /guardian of __________________________________, who is

currently enrolled at Cotabato Medical Foundation College this ____ semester
of SY __________.
2) I am aware that apart from classroom activities, he/she shall participate in off-
campus curricular activities, such as but not limited to: a) research activities
and field works b) recollection/retreats, 3) outreach programs/community
engagement, d) games and sports e) club activities, f) internship/related
learning experience/field study, g) academic and non-academic
competitions h) seminars, trainings and conventions
3) I hereby declare that I am allowing him/her to participate in such activities
provided that the said activities are authorized by Cotabato Medical Foundation
College;
4) I am aware that my son/daughter will be assigned in the various health care
facilities legally affiliated with Cotabato Medical Foundation College;
5) My son/daughter, under strict supervision, will observe the precautionary
measures mandated by the health care facility such as the wearing of personal
protective equipment for the special areas (OR, DR, and ER) and prescribed
equipment for other areas (wards);
6) That the protective equipment shall be at the expense of the student;
7) I am executing this affidavit to attest to the truthfulness of the foregoing facts, in
compliance with the requirements of the Commission on Higher Education,
other concerned government agencies (DOH, LGUs, etc.) and for whatever
legal purpose.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________ at

_______________, Philippines.

______________________
Signature over Printed Name
Gov’t ID # ____________

SUBSCRIBED AND SWORN to before me this __________________, at

__________________, Philippines, by the affiant who exhibited to me his/her competent
proof of identity as shown above.

Doc No.____________;
Book No. __________ ;
Page No. ___________;
Series of ___________.