B i c o l
U n i v e r s i t y
Legazpi City, Philippines
Parents’ /Guardians’ Permit Form
_____ semester, SY ______________
PLEASE TAKE NOTE CAREFULLY
1. Please fill up this form in BLOCK LETTERS.
2. ALL sections MUST BE COMPLETED when applicable.
3. Permit should be duly NOTARIZED for Educational Tour/Field Trip purposes and when participant is a minor.
TO WHOM THIS MAY CONCERN
This certifies that ____________________________________________, a ________________
(Course and Year)
of the College of ____________________________________ with Student No. ___________________
has the permission of his/her undersigned parent(s)/guardian(s) to participate and/or attend in the
______________________________________________________ on ________________, 20 _____
in _______________________.
This certifies further that risk assessment plans and necessary safety and precautionary
measures have been instituted.
Further, that the following faculty members shall accompany him/her in the travel.
1. ___________________________________
_____________________________
2. ___________________________________
_____________________________
3. ___________________________________
_____________________________
4. ___________________________________
_____________________________
Faculty Name (Please print)
Faculty Signature
Faculty Name (Please print)
Faculty Signature
Faculty Signature
Faculty Name (Please print)
Faculty Signature
Faculty Name (Please print)
Note: If the student is a minor, both parents MUST sign the permission form.
I/We have honestly and accurately completed all parts of the Parents’/Guardian’s
Permit Form to the best of my/our ability.
_________________________________
_________________________________
_________________________________
_________________________________
Parent/Guardian Signature #1
Date
Parent/Guardian Signature #2
Parent/Guardian Name (please print)
Date
Parent/Guardian Name (please print)
_________________________________
_________________________________
_________________________________
_________________________________
Complete Address
Contact Numbers
Complete Address
Contact Numbers
JURAT
On ________, of 20 ___, before me personally appeared, ______________________________
and ___________________________________ to me known to be the individual, or individuals
described in and who executed the within and foregoing instrument, and acknowledged that
he/she/they signed their free and voluntary act and deed, for the uses and purposes therein
mentioned.
Given under my hand and official seal this ______ day of _________________, 20 ____.
Notary Signature: __________________________
Notary Printed Name : ____________________________
Affix seal
here
My commission expires: ___________________________
BU OSS
Office of Student Services
Student Activities Section
S A S
BU-F-OSS-34
Effectivity: September 13, 2012
Revision No. 1
P. 1 of 1