Reference No.: BatStateU-FO-SOA-03 Effectivity Date: May 18, 2022 Revision No.
: 01
PARENT’S/GUARDIAN’S CONSENT FORM (WAIVER)
October 16, 2024
Date
TO ALL CONCERNED:
I, __________________________________ grant permission for my child/ward __________________
___________________________, a Grade 12 student of 12-Coulomb of the Senior High School
Department of this University, to join the SINAG 2.0: The IS Retreat on December 19-20, 2024.
With a brief description, to wit:
Name of the Activity SINAG 2.0: The IS Retreat
Date of the Activity/ Academic Year/ December 19-20, 2024
Semester
Date and Estimated Time of Arrival/Departure
a. Arrival December 19, 2024, 11:00 AM
b. Return December 20, 2024, 12:00 PM
Mode of Transportation Bus
Board and Lodging, if any Mt. Makiling Re-creation Center
Place(s) to visit/Location of the Event Sto. Bartolome, Sto. Tomas, Batangas
Further, as the Parent/Legal guardian, I am full aware that it is the primary responsibility of the Faculty-
in-Charge and of the University to supervise the students, I am also aware that the said persons should
demonstrate an acceptable standard of care and diligence. Furthermore, I consider their significant
responsibility for the safety and risk management when planning, preparing and supervising the activity.
However, I also recognize that there may be risks attributed to the activity which can only be avoided
through my son’s/daughter’s/ward’s extra diligence and due care, which I fully explained to my
son/daughter/ward.
By signing this document, it is understood that my child/ward:
a) Has been properly oriented with all the rules and regulations of the activity attached in this document
and that there may be additional rules and instructions that may be given from time to time. It is further
understood that he/she must comply with the aforesaid rules, regulations and instructions; otherwise,
he/she shall be excluded from further participation.
b) Shall exercise extra care and due diligence in participating in the activity; its consequences are fully
understood by him/her.
If in case that he/she is on the age of majority, he/she shall be made answerable for any and all liabilities
for damages to property or injury to himself/herself, to the University or its representatives and/or to third
persons which may be occasioned by his/her intentional or negligent act while in the course of the
implementation of the program.
If in case that he/she is a minor, I, as the parent/legal guardian will take full accountability on any and all
liabilities occasioned by his/her intentional or negligent act while in the course of the implementation of
the program.
________________________________________
Parent’s/Guardian’s signature over printed name
Contact Number:__________________________
Address :__________________________
Conforme:
_________________________________
(Student’s signature over printed name)
Name of Faculty-in-Charge: Mr. Jomari B. Montalbo
