MARIANO MARCOS STATE UNIVERSITY

College of Engineering
PROPOSED IMPLEMENTATION OF FACE-TO-FACE CLASSES

The undersigned parent/s/guardian whose printed name/s and signature/s appear below hereby declare
and state:
1. I/we am/are the parent/s/guardian of:
NAME OF STUDENT: ___________________________________________________________
2. A bona-fide MMSU student at the college/deparment of:
NAME OF COLLEGE/DEPARTMENT: ______________________________________________
3. Are aware that said student will be a part of the implementation of face-to-face classes according to
these guidelines as follows:
a. For fourth year students, all subjects will be in face-to-face classes
b. For lower years (1st year to 3rd year), laboratory subjects, excluding GE subjects, will be on face-to-
face classes. Other subjects will be virtually.
c. Major Exams, which includes Midterm and Final Exams, will be taken by a face-to-face approach.
d. Unvaccinated Students cannot enter the school premises.
4. I/we understand that MMSU shall implement the minimum public health standards set by the
government to minimize risk of the spread of COVID-19, but it cannot guarantee that my child will not
become infected with COVID-19, given that COVID-19 is highly contagious.
5. I/we understand that in-person attendance in school will include associating with professors, fellow
learners and school personnel, and other persons inside and outside of the school that may put my
child at risk of COVID-19 transmission, notwithstanding the precautions undertaken by the school.
6. I/we am aware that symptoms of COVID-19 include, but are not limited to, fever or chills, cough,
shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste
or smell, sore throat, congestion or runny nose, nausea, vomiting, and diarrhea.
7. I/we confirm that my son/daughter currently has none of those symptoms, and is in good health. I will
not allow my son/daughter to physically go to school to attend classes if my son/daughter or any
member of my household develops any of the said symptoms or any other symptoms of illness that
may or may not be related to COVID-19. I/we will also inform the school and not allow my child/ren to
attend face-to-face classes if my son/daughter or any of my household members tests positive for
COVID-19. My son/daughter and I/we, with my household members, will follow the required health and
safety protocols and procedures adopted by the school and our community.
8. To the extent allowed by law and rules, I/we hereby agree to waive, release, and discharge any and all
claims, causes of action, damages, and rights against the school and its personnel as well as officials
and personnel of the Mariano Marcos State University relative to the conduct of the activity.
9. With full understanding, I/we hereby freely and voluntarily give my consent to my son/daughter
participation in the face-to-face classes’ implementation. I also attest that I had sought the views of my
son/daughter and he/she has expressed willingness to participate in the activity.
10. IMPORTANT:
a. If this document is signed by only one parent, please state below the reason why the other parent’s
signature was not obtained. By affixing his/her signature the signing parent hereby takes full
responsibility for this consent/waiver.
__________________________________________________________________________
b. If this document is signed by a guardian, please state below the nature of the guardianship relation
and the legal basis thereof. The guardian or anyone who claims to act as such takes full
responsibility for this consent/waiver.
_____________________________________________________________________

____________________________ ___________________________
PARENT/GUARDIAN PARENT/GUARDIAN
(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME)

PERMANENT ADDRESS: ____________________________________________

____________________________________________
CONTACT NUMBER: ____________________________________________

We verified all the information/data herein provided and they are true and correct to our
own personal information and belief.

_________________________ ` _________________________
Dean Department Chair

#16S Quiling Sur, City of Batac, Ilocos Norte

 coe@mmsu.edu.ph  +63(77)600-34-58 www.mmsu.edu.ph