Malasaga Ojt Requirements 1

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EASTERN VISAYAS STATE UNIVERSITY

Tacloban City
Control No. EVSU-SASO-F-026
Title of Form: Parent’s Permit Revision No. 01
Date -

Date: July 4, 2023

We/I hereby grant permission to our daughter/son VENCE O. ROSALIJOS to participate in the On the Job
Training to be held at Eastern Visayas State University on Midyear of S.Y. 2022-2023.

We/I fully understand that all the necessary precautions will be taken into consideration to ensure safety and
well-being of my / our child for the duration of the said activity. However, we/I cannot hold the chaperon or instruction
or companion of the school responsibility for any incident or unforeseen circumstances that may happen beyond
control.

KRISSY ANNE E. CORREGIDOR


Parents / Authorized Guardian

I hereby certify that the signature that appears above is therefore genuine.

ENGR. ALBERT AZCARRAGA VENCE O. ROSALIJOS


_____________________________________________ _________________________________________
Signature over Printed name of the Adviser Signature over Printed Name of the Student

Recommending Approval:

OSCAR G. CABALUNA, PME RAMON I. LIM, PME


Signature over Printed Name of the Dept., Head Signature over Printed Name of the College Dean

Approved:

ERMY C. CABANGANGAN, MPM


Head, Student Affairs Office

ACKNOWLEDGEMENT

Republic of the Philippines)


City of Tacloban ) SS.

SUBSCRIBED AND SWORN to before this ____4TH__ ____day of_________ JULY_ ________, 20 23__ ,
TACLOBAN CITY, LEYTE ______, Philippines.
EASTERN VISAYAS STATE UNIVERSITY
Tacloban City
Control No. EVSU-SASO-F-122
Title of Form: Student Waiver Revision No. 00
Date

Date: June 26, 2023

Name of Activity On the Job Training


Type of Activity On the Job Training
Place of the Activity Eastern Visayas State University
Date/s of Activity Midyear of A.Y. 2022-2023

I hereby grant permission to my son/daughter to participate the above-mentioned activity.


I fully understand that all the necessary precautions will be taken into consideration to ensure the safety and
well-being of my son/daughter for the duration at the said activity. However, I cannot hold the
chaperon/instruction/companion at the school responsible for any on toward incident or unforeseen event that
may happen beyond control I hereby release and discharge the above-named sponsor from all liability
arising out of or in connection with the Above-describe activity.

Name of student participant VENCE O. ROSALIJOS

I/WE HEREBY AGREE that the student participant will comply with all of the above statements listed.

KRISSY ANNE E. CORREGIDOR VENCE O. ROSALIJOS


Signature over Printed name of the Parents Signature over Printed name of the Student

Recommending Approval:

RAMON I. LIM, PME


Signature over Printed name of the Head, Field Study Signature over Printed name of the College
and Student Teaching Department Dean

Approved:

Director, Student Affairs & Services Office

Student Address: BRGY 84, MANLURIP SAN JOSE TACLOBAN CITY


Student Contact Number: 09632448318

In event of illness or accident, please notify:


Name: KRISSY ANNE E. CORREGIDOR Relationship to Student: GIRLFRIEND
Address: BRGY 84 SAN JOSE TACLOBAN CITY
Contact Number: 09122580224

ACKNOWLEDGEMENT

Republic of the Philippines)


City of Tacloban ) SS.

SUBSCRIBED AND SWORN to before this ______4TH ___day of___ JULY_ ________, 20 23____,
TACLOBAN CITY, LEYTE ______, Philippines.
\
ATTACHMENTS TO PARENT’S PERMIT / WAIVER

1. Parent/ Guardian Valid ID ( The one who affix his / her signature in the Parent’s Permit )

_________________________ _________________________ _________________________


Parent / Guardian Signature Parent / Guardian Signature Parent / Guardian Signature

2. Student’s ID

__________________________ ___________________________ _________________________


Student’s Signature Student’s Signature Student’s Signature

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