2nd Semester CTWS 2 Adoption of PArents Consent

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Republic of the Philippines

MARINDUQUE STATE COLLEGE


Main Campus: Boac / Branches: Santa Cruz • Torrijos • Gasan
Panfilo P. Manguera Sr. Rd., Tanza, Boac, Marinduque 4900
Tel. No.: (042) 332-2028/2028 Email Address: osas_studentservices21@gmail.com
Trunkline: (042) 332-0662 Website: www.marinduquestatecollege.edu.ph
================================================================================================
OFFICE OF THE VICE PRESIDENT FOR STUDENT AFFAIRS AND SERVICES
OVPSAS ADVISORY
No. 019 series 2023

Date : 03 March 2023

To : All College Deans


All Concerned

Subject : ADOPTION OF PARENT’S/GUARDIAN’S CONSENT AND


WAIVER FORM FOR IN-CAMPUS AND LOCAL OFF-CAMPUS
ACTIVITIES (CURRICULAR/CO-CURRICULAR/ NON-
CURRICULAR)
Cc : Office of the College President, VPs, College and Board Secretary, CDs, SAS Directors, SSCF, File
=========================================================================================
1. The interest of public service so requiring and in line with our quest for
Universityhood and to ensure compliance with CMO No. 63 series 2017,
“Policies on Local-off
Campus Activities”, please be advised that all Colleges are enjoined to adopt and
use the attached Parent’s/Guardian’s Consent and Waiver for In-campus and Local
Off-campus Activities (Curricular/Co-curricular/Non-curricular).
2. Submission of this document shall be done at the start of classes with validity of
one Semester. The same shall be filed at the Office of the Dean for reference
purposes. This is to avoid multiple submission of students, especially if there will be
more than two (2) activities he/she will be attending in a semester. Making the
consent/waiver form available will also serve as a ready reference in case the
student will be attending urgent activities and other SAS-related participation such
as sports and culture and arts performances, volunteering and community outreach
and other similar activities.
3. Should there will be consent/waiver form that other organizers will be prescribing for
their activities, the same shall be utilized.

4. The template of consent/waiver form for Internship/OJT shall be provided by the


Office of the Vice President for Academic Affairs.
5. For information, reference, widest dissemination and compliance of all concerned.
Thank you!

MARVIN P. PLATA, MAN, RN, RM


Vice President for Student Affairs & Services

Vision: An advanced and adaptive university pursuing quality education, lifelong gender-sensitive learning environment, responsive research-
based community programs and transparent governance with sustainable resource generation by 2025.
Mission: To provide excellence in instruction, research, extension and production that magnifies WISDOM in leadership through Total Quality Management
System responsive to the challenges of the 21st century education.
Educating People, Enriching Lives and Expanding Opportunities with WISDOM!
ONE SAS for MarSU: Working Working together for an Exceptional Students Affairs and Services
Endeavors
Obedience, Neutrality, Excellence, Service, Actions, Solutions
Republic of the Philippines
MARINDUQUE STATE COLLEGE
Main Campus: Boac / Branches: Santa Cruz • Torrijos • Gasan
Panfilo P. Manguera Sr. Rd., Tanza, Boac, Marinduque 4900
Tel. No.: (042) 332-2028/2028 Email Address: osas_studentservices21@gmail.com
Trunkline: (042) 332-0662 Website: www.marinduquestatecollege.edu.ph
================================================================================================
OFFICE OF THE VICE PRESIDENT FOR STUDENT AFFAIRS AND SERVICES
PARENT’S/GUARDIAN’S CONSENT AND WAIVER FOR IN-CAMPUS AND OTHER
LOCAL-OFF CAMPUS ACTIVITIES (CURRICULAR/CO-CURRICULAR/NON-
CURRICULAR) NSTP-CWTS 2 - COMMUNITY IMMERSION PROGRAMS
& ACTIVITES
TO WHOM IT MAY CONCERN:
This is to certify that I willingly gave child, consent to my
, (Course) student
of MSC (College) to undergo a to
participate in In-Campus and Local-Off Campus (Curricular/Co-curricular/Non-Curricular)
within and outside the Province which will be implemented by the faculty members and
administrators of Marinduque State College for the fulfillment of the requirements for his/her
Program which may include: seminars/symposium, community outreach, sports events,
community immersion, research and extension activities, field trips, plant visits, tours other
similar activities as stated in CMO No. 63, series 2017. Provided that the details of such
activities are included in the Approved Course Syllabi of the faculty member, approved by the
head of agency or authorized representative or CHED (for activities to be conducted outside the
College per MSC Policy & CMO 63 series
2017 and CHED-DOH Joint Memorandum Circular No. 2021-001; 2021-04 and other relative
CHED issuances) and that I shall be informed of such activities prior to its implementation.
It is understood that my child will be monitored and reminded to abide by the rules and
regulations that may be imposed before, during and after the activity by the Marinduque State
College as Higher Education Institution (HEI) and the MSC partners and organizers for his/her
welfare, safety and security.
I fully agree to waive any responsibility on the part of the student-organizers, faculty
members and administrators of the Marinduque State College, the Partner Communities and
Organizers (for academic-related/in-campus/local-off campus activities), in case of untoward
incident/accident which may happen during the conduct of In-campus and Local-Off Campus
Activities (Curricular/Co-curricular/Non-Curricular which is/are due to the negligence of my
child and/or force majeure circumstances.

This document is valid this Second Semester of Academic Year 2023-2024.

Name of Parent/Guardian Signature Date Signed


Student’s Name:
Home Address:
Boarding House Address:
Parent’s/Guardian’s Contact Number/s:

WITNESSES:

Head, NSTP Director, Student Programs & Services

Subscribed and sworn to before me this at


affiant exhibiting to me their Valid ID/CTC
with No. issued at .

NOTARY PUBLIC
Vision: An advanced and adaptive university pursuing quality education, lifelong gender-sensitive learning environment, responsive research-
based community programs and transparent governance with sustainable resource generation by 2025.
Mission: To provide excellence in instruction, research, extension and production that magnifies WISDOM in leadership through Total Quality Management
System responsive to the challenges of the 21st century education.
Educating People, Enriching Lives and Expanding Opportunities with WISDOM!
ONE SAS for MarSU: Working Working together for an Exceptional Students Affairs and Services
Endeavors
Obedience, Neutrality, Excellence, Service, Actions, Solutions

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