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UNIVERSITY OF SANTO TOMAS NATIONAL SERVICE TRAINING PROGRAM

CIVIC WELFARE TRAINING PROGRAM/ LITERACY TRAINING PROGRAM

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NSTP
Dear Parents/Guardians: Your son/daughter/ward has expressed his/her intentions of joining the NSTP Fieldwork sponsored by the NSTP -n .4_ CWTS/LTS office to be held on at : 4 ( 01 ( .7 1 /: L C % p{ ,/ )( ' To ensure the safety of your son/daughter/ward, please be informed of the
following standard operating procedures for all official off-campus in the university: I. MS. HEIDEN ANORICO, a Faculty Member from the NSTP

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Department will be accompanying the students. You may contact him/her at 4061611 loc 8475 or 8567 for further inquiries. 2. An ocular visit and coordination with the community leaders have been done by the university representatives. 3. The facilities proximate to the venue which may be necessary for emergency situations have been identified. Should you allow your son/daughter/ward to join the aforementioned, kindly fill-out the attached " atement of Parental Cons nt" and return the same to the NSTP CVVTS/LTS Office on or before Alj,?/ ."-2X Noted: Eno, ed N ANORICO Fa ulty M ,mber ASSOC. SE RI AR ORIGENES M . J O C R U Z Ill UST NSTI CWT /LTS Moderat r tor

STUDENT UNDERTAKING AND STATEMENT OF PARENTAL CONSENT

a student of the Faculty/College and with address located at with the contact number____________ hereby express my intention to join the NSTT' ' FIELDWORK organized by the UST NSTP CWTS/LTS Office, to be held on_____________________________________________________________________ at In connection with the above mentioned activity, I hereby warrant and represent that:
I understand that the aforementioned extracurricular activity was organized by the recognized academic society of the Office for Student Affairs of which I am a member of good standing, and that my participation in the said activity is voluntary and for the primary purpose of achieving my holistic growth as an individual and enhancing my personal development, especially as a student of the University of Santo Tomas. 0. Having volunteered attendance and participation in such activity. I take it as my responsibility to take it as my (1111, responsibility to take the necessary precaution or care of avoiding or getting involved in any incident that would cause slight, serious or mortal injury upon my person or result in the loss or damage to my property and that of other people's. 1.

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3. I also understand that I am not to engage in any behavior that could or may lead to any incident or could result to loss 4. or damage to property, injury to myself or other person(s). I understand that it is my responsibility to fully ascertain, if necessary with the help of a medical professional, my physical and mental fitness to join such activity.

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I understand that I must be sufficiently healthy or free from any medical condition that may be exacerbated or aggravated by my participation in such an activity. Should I be suffering from any medical condition that may be aggravated or exacerbated by such an activity, I commit to immediately report such condition in writing to the assigned faculty adviser and excuse myself from such an activity . I have properly informed my parents or the person(s) exercising parental authority over my person of the nature of the activity which I am joining and assured them that the faculty adviser(s)/ facilitator(s) accompanying us will ensure my personal safety and security. I have likewise secured my parent's/ guardian's advice on the measures Which I am to undertake for my personal safety and security, and furthermore, secured their consent for me to join such an activity as evidenced by the signature appearing in this form for parental consent. I am fully convinced that the faculty adviser(s)/facilitator(s) and organizer(s) of this particular activity, considered as the rightfully designated representatives of the University of Santo Tomas, have proven to us the exercise of sufficient diligence and care in the preparation and implementation of this activity, and for that reason, I reiterate that any resulting loss, damage, injury that may be experienced should be discussed from the vantage of inevitable eventually.

ATTENTION: FOR THE PARENT OR PERSION EXERCISING AUTHORITY OVER THE STUDENT CONCERNED. AFFIXING YOUR SIGNATURE HEREIN SHALL MEAN THAT YOU CONFORM TO THE CONDITIONS STATED ABOVE AND CONSENT TO THE PARTICIPATION OF YOUR SON/DAUGHTER/WARD IN THE SAID ACTIVITY.

NAME AND SIGNATURE OF STUDENT________________________________________________________________________

NAME AND SIGNATURE OF THE PARENT_____________________________________________________________________