BATANGAS STATE UNIVERSITY

College of Engineering, Architecture and Fine Arts

Gov. Pablo Borbon Campus II, Alangilan, Batangas City, Philippines 4200
www.batstate-u.edu.ph
Telefax: (043) 300-4404 locs. 106-118

ECE / ICE / MEXE Department

PARENTS CONSENT WAIVER

I,___________________________, with student number _____________, residing at
__________________________________________and a student of BS Instrumentation and
Control Engineering at Batangas State University, Batangas City, hereby voluntarily agree
to undergo the conduct of FT 513 Field Trips and Seminars for ICE as part of the BS ICE
curriculum for the first semester of AY 2016-2017 This is to acquire additional learning
experience in relation to the instrumentation and control engineering field under the following
terms and conditions:
1.

That I shall abide by all the university rules and regulation and shall act accordingly

2.
3.

as a student;
That I shall exercise care and diligence within the duration period of the field trip;
That I shall renounce and waive my claim against the school/ industry/ establishment
for any injury I suffer personal or pecuniary, in the performance of my duties and

4.

function while participating in the said course;

That I shall be made answerable for any and all liabilities for damages for property or
injury to third person, which may be occasioned by my intentional or negligent act
while in the course of the event.

Signed

on

this

_______

day

of

________________________,

2016

at

___________________________________, Philippines.
_________________________________
Students Signature over Printed Name
Student No.: _____________

With the consent and approval of Parent/Guardian:

________________________________________
Signature of Parent/Guardian above Printed Name
Address: _________________________________________________________________
Contact No.: _________________________

ATTESTED:

Engr. Mirasol C. Dilay

Adviser, FT 551Fieldtrips and Seminars for ICE

SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of ____________,

2016 at _________________, Philippines.