Republic of the Philippines

UNIVERSITY OF SOUTHERN MINDANAO KIDAPAWAN CITY CAMPUS

Sudapin, Kidapawan City North Cotabato

ACKNOWLEDGMENT

I/we, the parent / guardian(s) of , a student of the

College of , hereby acknowledge that
I/We am/are fully aware that the required off-campus curricular activity/Pre-Service Training/
Internship/ OJT Training/ Plant Visit/Seminar/Workshop/ Convention/ Competition/ Educational
Trip/ (title) to be undertaken by
my son/daughter/ward is an integral part of the (Name of Org./Program) being
the (Position) and also part of the academic work leading to the completion of his/her
degree program.

Furthermore, I/we acknowledge the following:

That every above-mentioned activity that my son/daughter/ward participates in may involves
risk(s) which is/are beyond the control of the College/University;
That I/we fully believe that the management of the University leaves no stone unturned to
promote and safeguard the welfare and safety of my son/daughter/ward;
That in case of any untoward incidents during the conduct of the off-campus curricular activity/
Pre-Service Training/ Internship/ OJT Training/ Plant Visit/ Seminar/Workshop/ Convention/
Competition/ Educational Trip due to circumstances beyond the control of the Adviser and/or Faculty
Chaperon(s), in particular and University, in general, I/we shall not hold them liable nor I/we file a
complaint against them.

Signature over Printed Name

PARENT/GUARDIAN

SUBSCRIBED and SWORN to before this day of 20 , with the

affiant exhibiting to me his/her Community Tax Certificate No. , issued on
at .

Doc No.
Page No. NOTARY PUBLIC
Book No.
Series No.

USMKCC- OSA -F-007