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Affidavit of Parental Consent For International

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REPUBLIC OF THE PHILIPPINES) s.s.

_____________________________)

AFFIDAVIT OF PARENTAL CONSENT

Type Parent/Guardian’s Name


I/We, ____________________________________ Type Parent/Guardian’s Name
and ____________________________________,
of legal age, Filipino/s with residence at _____________________________________________________,
Insert address here
after having been duly sworn in accordance with law, hereby depose and say that:

Student’s name
1. I/We am/are the parent/s or guardian of ___________________________________________
Do not abbreviate please
who is a student of the College/Faculty/Institute of _____________________________________ of the
Do not abbreviate please
University of Santo Tomas (UST) pursuing a degree in ____________________________________;

Title of Activity or Event


2. I/We am/are aware that my/our child or ward will join _________________________________
activity sponsored by _________________________________________________
Name of Organization or Organizer/s and endorsed by
Name of Office or Department
___________________________________________ at:

Name of Activity Address Starting On Ending On

3. I/We have advised my/our child/ward to take the necessary precaution to avoid or get
involved in any incident that could cause loss, damage or injury to his/her person or that of another;

4. I/We understand that it is my/our responsibility to fully ascertain, if necessary, with the help
of a medical professional the physical and mental fitness of my/our child/ward to join such activity;

5. I/We certify that my/our child/ward is healthy or free from any medical condition that may
be exacerbated or aggravated by his/her participation in such an activity. Should my/our child/ward be
suffering from any medical condition that may be exacerbated or aggravated by participating in such
activity, I/we commit to report the same in writing to the faculty coordinator;

6. I/We have advised my/our child/ward to strictly observe UST’s and the Institution’s rules on
security, confidentiality of business information or other regulations in relation to the said training;

For international
UST:SO30-00FO96
7. I/We understand the nature of the activity and I/we hereby give my/our consent and
permission for my/our child/ward to join or participate in the said activity;

8. I/We are executing this affidavit in compliance with the requirements of the Commission on
Higher Education.

IN WITNESS WHEREOF, I/we have hereunto set my/our hands this _____ day of
________________ at ___________________.

_____________________________ ______________________________
Father/Guardian Mother
Affiant Affiant

______________________________
Student

SUBSCRIBED AND SWORN to before me this __________ day of _____________________ at


_______________________, affiant/s exhibited to me his/her/their Government I.D. Nos. __________
and _____________ issued by __________________.

NOTARY PUBLIC

Doc. No.
Page No.
Book No.
Series of

For international
UST:SO30-00FO96

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