Scribd
Upload
27 views2 pages

NSTP 1 Waiver

This document contains a parent approval and medical release form for student Ella Marie C. Gavileño to participate in an off-campus NSTP activity from May 29 to June 6, 2023 in Calamba City. The parent approves of and provides medical authorization for the trip, acknowledging the student will be under supervision of the instructor. In case of medical emergency, the parent consents to treatment and will be responsible for costs. Relevant medical information and emergency contacts are also provided.

Uploaded by

Ella Marie Gavileno
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
27 views2 pages

NSTP 1 Waiver

This document contains a parent approval and medical release form for student Ella Marie C. Gavileño to participate in an off-campus NSTP activity from May 29 to June 6, 2023 in Calamba City. The parent approves of and provides medical authorization for the trip, acknowledging the student will be under supervision of the instructor. In case of medical emergency, the parent consents to treatment and will be responsible for costs. Relevant medical information and emergency contacts are also provided.

Uploaded by

Ella Marie Gavileno
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Parent Approval

Student’ Name: Ella Marie C. Gavileño Yr. & Sec.: First Year – BSP221B
Destination: (Partner Community) Trip Date: Series of activities
Calamba City from May 29 – June 6, 2023

I, the undersigned parent/guardian of Ella Marie C. Gavileño do hereby authorize my son/daughter to


participate in an off-campus activity. I am aware that the off-campus activity requires travel with-in
and/or outside Calamba City and I have been informed of the details regarding the off- campus activity,
including the destination/s, mode/s of transportation, name/s of adult chaperones, time and place of
departure, and return. I understand that during this off-campus activity, my son/daughter will be under
the direction and general supervision of the NSTP Instructor, Dr.Alathea S. Jimenez, College of Arts
and Sciences (college/dept.) and Team Leader and that my son/daughter is subject to discipline for
his/her conduct during the activity.

Medical Release

In the event my son/daughter needs medical attention during the off-campus activity, I hereby give my
permission to the College of Arts and Sciences (college/dept.) representatives for
the trip to take my son/daughter to a physician, hospital, or other medical institution for treatment. I
expressly authorize any and all medical treatment which a physician may determine necessary under
the circumstances and understand that it may not be feasible to contact me prior to the provision of
medical treatment to my child. I understand and agree that I, and or my son/daughter’s other parent(s)
or legal guardian(s), will be responsible for all medical expenses incurred in treating my son/daughter
and that College of Arts and Sciences (college/dept.) representatives for the off-
campus activity are not responsible for such expenses. Any medical expenses incurred in treating my
son/daughter could be reimbursed provided that the medical expenses could be covered under the
Student Insurance Policy provided by the university.

In addition, I authorize the College of Arts and Sciences (college/dept.)


representatives for the off-campus activity to dispense/give the prescription/non-prescription
medication indicated on this form to my child as appropriate. I understand that I must complete this
form and provide to school representatives any medication/s indicated that should be dispensed/given
to my son/daughter during the off-campus activity.

Medical condition/s, including allergies, that may affect the student during off-campus activity:
________________________________________________________________________________
_______________________________________________________________________________________

Medications/s: List any medication that the student should take while on the off-campus activity,
the instruction for administration, and the medical condition for which the medication is needed.
•
NU LAGUNA
STUDENT DEVELOPMENT
AND ACTIVITIES OFFICE

Release Form

Name of Parent/Guardian: Ladybird C. Gavileño


Landline No.: N/A Mobile No.: 09498703040
Name of Emergency Contact Person (aside from parent/guardian): Ricky T. Gavileño
Contact No. of Emergency Contact Person: 0920 964 3397

Signature over Printed name of Parent/Guardian:

LADYBIRD C. GAVILEÑO

Date:
May 29, 2023

This waiver is applicable only to


all NSTP 1 Community Immersion
related activities for this Academic
Year 2022-2023, 3rd term.

Km. 53, Pan Philippine Highway, Brgy. Milagrosa, Calamba City, Laguna (049) 572-3356 www.nu-laguna.edu.ph

You might also like