Informed Consent for the Limited Face-to-Face Classes

I (Full Name)__________________________, ____ years old, currently enrolled in the

academic program ________________________ hereby consent to participate in the Limited
Face-to-Face classes of Panpacific University for the Second Trimester of Academic Year 2021 -
2022.

I am aware that I have to comply with the set health and safety protocols inside and outside of
the university to ensure the protection of all the students, teaching and non-teaching staff as well
as the other constituents.

Furthermore, this certifies that I fully understand the guidelines and details of the Limited
Face-to-Face classes to be implemented by Panpacific University through the conducted General
Consultation and Meeting held on October 21, 2021, and School-based Consultation and
Meeting held on November 3, 2021. (please indicate the date of your school-based orientation)

_____________________________
Student Signature over Printed Name

Date: ___________________

***

As the parent or legal guardian of (Name of Student) ______________________, I hereby

acknowledge that I have been informed of the details of the conduct of the Limited Face - to -
Face classes of Panpacific University.

I understand that Panpacific University shall implement health and safety protocols to minimize
the risks of the spread of COVID-19, however, there is no guarantee that my child will not be
infected with COVID-19, given that it is highly contagious.

_____________________________
Parent/Guardian Signature over Printed Name

Date: ___________________