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Off Campus Activity Forms Copy 6

CAF

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Edgardo Laxamana
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55 views

Off Campus Activity Forms Copy 6

CAF

Uploaded by

Edgardo Laxamana
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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DON HONORIO VENTURA STATE UNIVERSITY

Bacolor, Pampanga

ROLE OF PERSON-IN-CHARGE (PIC)

Duties and Responsibilities of PIC

1. Accompany the students from the time they assemble for the off-campus activity up to

debriefing.

2. Ensure the provision of the allowable seating capacity of the vehicle(s) used. (No student should

be allowed to ride on the roof of motor vehicle or on the boarding platform).

3. Ensure that program of activities is properly followed as planned or activities can be adjusted as

the need arises.

4. Have first aid kit available anytime.

5. Coordinate to the proper authorities in case of untoward incident such as accidents, injury, etc.

6. Make the necessary recommendation (s), in case of bad weather, either to cancel/postpone the

said activity.

Reference:

CHED Memorandum Order #63 series of 2017

OSA Form 003


Series 2017
DON HONORIO VENTURA STATE UNIVERSITY
Villa De Bacolor, Pampanga

OFF-CAMPUS ACTIVITY FORM


NON-CURRICULAR ACTIVITY

Date Filed ______________________


Name of Organization: _____________________________________________________________

Activity: Seminars/Trainings/Conventions/Conferences and Team building


Community Outreach and Immersion
Sports Activities
Inter School Competitions
Cultural Competition

Date of Activity: From: _____________________ To ________________________________


Venue _________________________________________________________________
No. of Participants _________________________________________________________________
Officer-in-Charge ____________________________Position______________________________
President Vice President Others, please specify __________________________________________
_____________________________________________________________________________________________
Advisers Undertaking

We hereby declare that we have knowledge of and consented to the holding of the abovementioned
activity. We hereby undertake to be present throughout the said activity to oversee the behaviour of the
participants and ensure with utmost diligence, their safety and physical well-being.
This, however, shall not in any way be construed as an admission of personal liability which may result from the
said activity, unless the same is clearly shown to have been caused by our own negligence or omission.

________________________________ _______________________________________
Signature over Printed Name of Adviser Signature over Printed Name of Adviser

Attested by:
________________________________
College Dean/Campus Director
____________________________________________________________________________________________

For overnight activity: Duly notarized parental consent for each participant
For whole day activity: Acknowledgement letter from parent/guardian with photocopy of
parents/guardian’s valid ID with specimen signature
Itinerary for the activity
Medical Certificate/Clearance (for physical and/or strenuous activities) issued by the University
Physician
Meeting with parents of attendees (optional)
Breakdown of expenses (for organizational tour)
Attendance Sheet

___________________________________________________________________________________________
Reminders: To be submitted one (1) week after the activity
 Learning journals
 Assessment report/Evaluation Report by faculty
 Financial Report (Breakdown of Expenses

_________________________
______
Signature over printed name of student

Approved:

GLORIA B. GIGANTE, Ed.D


Director, Student Affairs
OSA Form 003
Series 2017
DON HONORIO VENTURA STATE UNIVERSITY
Villa De Bacolor, Pampanga
Officce of the Student affairs

OFF-CAMPUS ACTIVITY

ATTENDANCE SHEET

Name of Student Signature Date


Morning Session Afternoon Session
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

I hereby certify that the above listed students personally appeared before me on the date as
specified

________________________________

Person-In-Charge

OSA Form 003


Series 2017

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