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IECEP-QCSC WAIVER

Date:_________________

Dear Sir/Madam:

The undersigned wishes to inform you that your child / ward


____________________________together with his / her classmates will undertake an off-
campus activity, PALAIECEPAN2017:SIPAG DAKO, on September 02, 2017 at Jose Rizal
University, Mandaluyong City in preparation for the 2017 IECEP Annual Electronics
Engineering Interscholastic Quiz Show.

In view of this, we wish to obtain your consent for him / her to join this activity by signing the
waiver below.

Thank you.

Truly yours,

Engr. Efren T. Pineda


Adviser, IECEP-QCSC

CONSENT

We / I, _________________________, parents / guardians of _________________________,


____ Year Electronics Engineering Student, hereby affix our / my signature as a proof of our /
my consent to our / my child’s joining the PALAIECEPAN2017:SIPAG DAKO, on September
02, 2017 at Jose Rizal University, Mandaluyong City.

We / I, hereby hold free and harmless IECEP-QCSC and any of its officers in the event of any
accident, injury or sickness that may befall our / my child during the activity knowing that the
school shall and will exercise extraordinary diligence.

Signed this ____ of ___________,201_ in _________________________________________.

_______________ __________________________
Relation Signature over printed name
CONSENT

We / I, _________________________, parents / guardians of _________________________,


____ Year Electronics Engineering Student, hereby affix our / my signature as a proof of our /
my consent to our / my child’s joining the PALAIECEPAN2017:SIPAG DAKO, on September
02, 2017 at Jose Rizal University, Mandaluyong City

We / I, hereby hold free and harmless IECEP-QCSC and any of its officers in the event of any
accident, injury or sickness that may befall our / my child during the activity knowing that the
school shall and will exercise extraordinary diligence.

Signed this ____ of ___________,201_ in _________________________________________.

_______________ __________________________
Relation Signature over printed name

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