OSAS-QF- 25
Republic of the Philippines
CAVITE STATE UNIVERSITY
Don Severino delas Alas Campus
Indang, Cavite
(off-campus activity)
STUDENT INFORMATION
_________________________ _________________________ _____ ____
Last Name First Name M.I Sex Date of Birth
_____________________________________________________________
Mailing Address Student Number
Contact Number: _______________________ Academic
Non-Academic
Name of Organization: NSTP 2-CWTS Performing Arts Group
Name of Adviser/s in charge: MANNY JULIUS G. YLARDE Signature: _________________________
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PARENT/GUARDIAN PERMIT/CONSENT
This is to certify that I have full knowledge of and permission for my son/daughter/foster
child to join and participate in:
Title of Activity: NSTP 2-CWTS Community Immersion
Date & Time of the Activity: April 26, 27, 28, May 3,4,5,10,11,12,17,18,19,24,25,26, June 1,2,7,8,9,14,
15,16,21,22,23, 2024
Place of Activity: Indang, Mendez, Trece
I concur and agree on the rules, policies & regulations being implemented by the concerned
organizers.
___________________________________ _____________________________
Name & Signature of Parent/Guardian Contact Number
Subscribed & sworn to me this _______day of _______________ 2024 at ________________
vxx-yyyy-mm-dd