Republic of the Philippines

Department of Education
Region III – Central Luzon
Tarlac City Schools Division
CENTRAL AZUCARERA DE TARLAC HIGH SCHOOL
Central, Tarlac City

Waiver for the Film Viewing at SM

In consideration of CAT HS permitting:

Student’s Name: ____________________, Grade _______________ to participate in

Film Viewing at SM on: ________________________. Departure: 9:30 am at school
quadrangle but the actual watching time is 11:00am to 1:00pm. After the film viewing,
students could enjoy the rest of the time at SM and go home for their own arrangement.
The cost of the ticket is___________,

I acknowledge and accept that my son’s/ daughter’s (the student name above)
participation in the CATHS Film Viewing on the venue stated above is entirely and
voluntarily and all risk is voluntarily assumed by my son/ daughter and me.

I understand that the school rules and regulations will be in effect. I have also ensured
that my son/ daughter understand that it is important for his/her safety, and for the safety
of the group, that all rules and instructions given by teachers/film viewing organizers are
obeyed.

In consideration of your agreeing to take my son/daughter on the above film viewing, I

hereby agree not to hold the school, any individual employed by the school liable for any
expense, loss, personal injury, or accident to my son/ daughter which is not the result of
any negligent act or willful default of any employee or agent of the school. I will not
bring any suit or assert any claim against CAT HS administration, faculty and staff as a
result of any action taken.

PLEASE CHECK THE BOX, DATE AND SIGN BELOW

I have carefully read the Waiver and Permission Agreement and understand the terms
and conditions of it and agree to be bound hereby. The Child has the undersigned’s
permission to participate in the film viewing and have the charge billed to the child’s
account.

Signature of Parent or Guardian: ____________________________ Date: ____________

PLEASE ENSURE THAT YOUR CHILD RETURN THIS FORM NO LATER THAN
____________________.