Republic of the Philippines

Department of Education
Region III-Central Luzon
Schools Division of Bulacan
Asian Institute of Science and Technology
Plaza Naning Victoria Bldg. Baliwag, Bulacan
SENIOR HIGH SCHOOL DEPARTMENT

CONSENT AND WAIVER FOR CONDUCTING SURVEY LOCALLY OFF CAMPUS

I understand that part of the program at Asian Institute of Science and Technology

(AISAT) involves allowing students off campus to conduct survey related to their

research. I hereby permit and consent my child to leave campus during school hours

and to visit places required to conduct their surveys and interviews. I understand that

my child will be with other children. I will not receive advance notice for these

spontaneous excursions and other programs that naturally occur during the school day.

I voluntarily and willingly assume responsibility for all risks and dangers associated with

my child’s participation in conducting survey for their research. In consideration of my

child’s participation, I waive all claims or causes of action against Asian Institute of

Science and Technology (AISAT), its officers, directors, and employees, arising out of

my child’s participation in the research, and hereby release, hold harmless and

discharge Asian Institute of Science and Technology (AISAT) and its officers, directors,

employees and agents from all liability, except for gross negligence or willful

misconduct.

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Parent/Guardian Signature Date

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Parent/Guardian Signature Date