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MARY MOUNT SCHOOL OF KORONADAL INC. MARY MOUNT SCHOOL OF KORONADAL INC. MARY MOUNT SCHOOL OF KORONADAL INC.

Baldostamon Subdivision, City of Koronadal Baldostamon Subdivision, City of Koronadal Baldostamon Subdivision, City of Koronadal
Tel. No. (083) 228-3675 Tel. No. (083) 228-3675 Tel. No. (083) 228-3675

GUARDIAN / PARENTS GUARDIAN / PARENTS GUARDIAN / PARENTS


CONFORME FORM CONFORME FORM CONFORME FORM

Type of Activity: VALENTINES BALL Type of Activity: VALENTINES BALL Type of Activity: VALENTINES BALL
Venue: EMR HALL Venue: EMR HALL Venue: EMR HALL
Date: FEBRUARY 7, 2020 Date: FEBRUARY 7, 2020 Date: FEBRUARY 7, 2020
Time: 5:30 P.M Time: 5:30 P.M Time: 5:30 P.M

To: To: To:

I hereby willingly and voluntary consent to the I hereby willingly and voluntary consent to the I hereby willingly and voluntary consent to the
participation of my child participation of my child participation of my child

_________________________________________ _________________________________________ _________________________________________


(Name of Student) (Name of Student) (Name of Student)

To the above mentioned activity. I have considered To the above mentioned activity. I have considered To the above mentioned activity. I have considered
that I will not hold any party responsible for any that I will not hold any party responsible for any that I will not hold any party responsible for any
untoward incidents which may happen in the course untoward incidents which may happen in the course untoward incidents which may happen in the course
or duration of the activity as long as proper care and or duration of the activity as long as proper care and or duration of the activity as long as proper care and
due diligence are observed to ensure the safety and due diligence are observed to ensure the safety and due diligence are observed to ensure the safety and
security of my child. security of my child. security of my child.

_________________________________________ _________________________________________ _________________________________________


Signature of Parent/Guardian Over Printed Name Signature of Parent/Guardian Over Printed Name Signature of Parent/Guardian Over Printed Name

Address: __________________________________ Address: __________________________________ Address: __________________________________


Contact Number: ___________________________ Contact Number: ___________________________ Contact Number: ___________________________

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