Our Lady of the Pillar College-San Manuel, Inc.

District 3, San Manuel, Isabela

PARENT/ GUARDIAN CONSENT FORM

TO WHOM IT MAY CONCERN

This s to certify that I/we allowed my son/daughter to join the GRADUATION RETREAT as
requirement for graduation.

Name of son/daughter
Name of Activity
Date of Activity
Venue of the Activity
Retreat and Transpo. fee
GRADUATION RETREAT
FEBRUARY 7- 9 2019
STA. CATALINA SPIRITUALITY CENTER, BAGUIO CITY
3,150

I/We hereby give the full consent for him/her to attend the said activity with the following conditions:

1. Our son/daughter will be chaperoned or escorted by the Instructor/Dean.

2. The chaperone will see the safety, behavior and physical upkeep our son/daughter as far as
humanly is possible.
3. Considering the above conditions and the benefits that our son/daughter will derive from
his/her participation in this activity, and realizing that every precaution will be be undertaken by
the chaperone and your office.

________________________________ ____________________
Name and Signature of Parent/Guardian Date

CESAR P. BATALLER ROMEO U. YDIA JR.

Christian Formation Coordinator Student Affairs and Services Officer

STUDENT WAIVER

I, _________________________ (name) presently enrolled in ________________ ( course/year)

present myself to join the GRADUATION RETREAT at Sta. Catalina Spirituality Center, Baguio
City as requirement for graduation and do hereby pledge that:

1. I will obey and abide the rules promugalted, enforced by the school officials for the protection
and safety of all;
2. That I hereby waived and renounce my rights to all damages, hospitalization, and the like and I
will not hold the employees or staff of MUST responsible for any misfortune, injury, or accident
be slight or serious, that may happen in connection with the activity. The cause of which will be
attributed to my acts of my disobedience, negligence, and the offense of my heading to advice,
warning, precaution, and safety rules that were read to me by the officer in-charge before the
start of the activity.

That the consent of this waiver was read and explained to me before I affix my name and
signature this ______ day of _____________, 20____ freely and voluntarily.

________________________________ _______________________________
Name and Signature of Student Name and Signature of Parent/Guardian

Date:________________