02 August 2019

Dear Parents,
Good day!
We, students from De La Salle University taking up Master of Science in Teaching Mathematics, will be
conducting a Lesson Study on Thursday, August 08, 2019 at Bro. Andrew Building De La Salle
University. This is one of our required tasks in the course SCE612M (Teaching of Mathematics). Your
son/daughter has been chosen to be one of the participants in the said activity. In line with this, we
would like to ask you to sign the waiver and consent form below.
Thank you very much for your cooperation.

Sincerely,

Arcilla, Rochell
Dy, Emmanuel Henry
Fariscal, Eliza Mariz
Mapile, Romyna Fortuna

Noted by:

MR. LEVI E. ELIPANE

Course Facilitator

WAIVER AND CONSENT FORM

I completely understand and realize that participation in the above mentioned activity might include
unfavorable incidents that could lead to some dangerous outcomes to my son/daughter.
By signing this waiver and consent form, I agree to the fact that participation might cause accidents to
my son/daughter. I release De La Salle University from all liability, costs, and damages which could
arise from participation in the above named activity. I agree to accept financial responsibility for the
costs related to this emergency treatment and give my confirmation of the same by signing this
document.

Name of Participant:
____________________________________________________________________________________
Name of Parent or Guardian:
____________________________________________________________________________________
Signature of Parent of Guardian: ______________________________ Date: _______________