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Written Consent Form for Recollection

The document is a written consent form for students participating in the Recollection Activity at Don Mariano Marcos Memorial State University for the Academic Year 2024-2025. It outlines the objectives of the activity, which include deepening spirituality and reconnecting with faith, and requires signatures from both the student and their parent/guardian. Additionally, it includes a release of liability and emergency contact information, emphasizing the necessity of submitting the form to participate.

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Cherry Ann Diocares
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2 views

Written Consent Form for Recollection

The document is a written consent form for students participating in the Recollection Activity at Don Mariano Marcos Memorial State University for the Academic Year 2024-2025. It outlines the objectives of the activity, which include deepening spirituality and reconnecting with faith, and requires signatures from both the student and their parent/guardian. Additionally, it includes a release of liability and emergency contact information, emphasizing the necessity of submitting the form to participate.

Uploaded by

Cherry Ann Diocares
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY

South La Union Campus, Agoo, La Union, Philippines


COLLEGE OF EDUCATION
www.dmmmsu.edu.ph|(072) 687-0063

Written Consent Form for RECOLLECTION ACTIVITY


College of Education
School Year 2024-2025

This form serves as written consent for the student named below to participate in RECOLLECTION ACTIVITY
for the Academic Year 2024-2025.

Student Information: Parent/Guardian Information:


Full Name: ______________________________________ Full Name: _____________________________________
Program/Year Level: ______________________________ Relationship to Student: _________________________
Student ID Number: ______________________________ Contact Number: _______________________________
Contact Number: _________________________________ Email Address: _________________________________
Email Address: ___________________________________

Objectives of the RECOLLECTION:


1. To deepen the spirituality of the graduating students.
2. To reconnect with one's faith and relationship with God.
3. To be able to identify the importance of God in their lives and to their future career.
Acknowledgement and Consent:
By signing this form, the student and parent/guardian (if applicable) acknowledge and agree to the following:
1. Consent to Participate:
I, the undersigned student, voluntarily agree to participate in the recollection activity as part of my
graduating requirements for the school year 2024-2025.
2. Parental/Guardian Consent
I, the undersigned parent/guardian, give my consent for my child/ward to participate in the
recollection activity. I understand the nature of the program and the potential risks involved.
3. Release of Liability:
I release CE from any liability for injuries, illnesses, or other unforeseen circumstances that may
occur during the activity, provided that such incidents are not due to negligence or misconduct on
the part of the institution or its affiliates.
4. Emergency Contact:
In case of an emergency, I authorize CE and its affiliating institutions to contact the following
person(s):
o Name: ________________________________________________________
o Relationship: ___________________________________________________
o Contact Number: ________________________________________________

Student’s Signature: Parent/Guardian’s Signature:

___________________________________ ___________________________________
(Name and Signature of Student) (Name and Signature of Parent/Guardian)
Date: ________________________ Date: ________________________

For Office Use Only:


Noted by:

____________________________________________
(Name and Signature of SAS)

Noted by:

____________________________________________
(Name and Signature of Spiritual Facilitator)

Approved by:

____________________________________________
(Name and Signature of Dean)
Date: ________________________
DON MARIANO MARCOS MEMORIAL STATE UNIVERSITY
South La Union Campus, Agoo, La Union, Philippines
COLLEGE OF EDUCATION
www.dmmmsu.edu.ph|(072) 687-0063

Note: This form must be submitted to the CCHAMS office before the RECOLLECTION. Failure to submit this form may result in the student’s inability
to participate in the program.

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