PERPETUAL HELP COLLEGE OF MANILA

1240 V., Concepcion St., Sampaloc Manila

COLLEGE OF NURSING

CONSENT FORM

I, Mr./Ms. __________________, residing at ___________________________________, parent of

_______________________, who is studying in Second Year, College of Nursing, Perpetual Help College
of Manila hereby state the following:
1. I voluntarily give my consent for my son/my daughter/my ward, __________, to attend the
limited face-to-face classes to be conducted in Perpetual Help College of Manila (the school) as
allowed under the rules and regulations of the Commission on Higher Education (CHED) on the
gradual reopening of campuses of higher education institutions for limited face-to-face classes
during the COVID-19 Pandemic, wherein the School, which is situated within an area under
COVID 19 Alert Level 2, may start limited face to face classes anytime, in relation to the
implementation of Phase 2 of the limited face to face classes for all programs of higher
education institutions and consistent with the related mandate of the Inter-agency Task Force
and pertinent CHED issuances.
2. I faithfully represent that my son/my daughter/my ward is medically insured (with COVID 19
Coverage), and fully vaccinated against COVID 19 Virus as required under the rules and
regulations of the Commission on Higher Education (CHED) on the gradual reopening of
campuses of higher education institutions for limited face-to-face classes during the COVID-19
Pandemic, to be qualified to attend the face-to-face classes.
3. I faithfully represent that I had my son/my daughter/my ward are fully aware of the risks of
COVID-19; and hence, my son/my daughter/my ward will exercise extraordinary diligence to
protect himself/herself against COVID 19 at all times, and specifically in going to/from and while
attending the face-to-face classes. Further, my son/daughter/my ward will comply with all the
health protocols prescribed by the School’s affiliated hospitals where he/she will be assigned or
where he/she will be physically present.
4. In the event that my son/daughter/ward contracts COVID 19 o other sickness in relation to the
aforementioned face to face classes, the consequent expenses shall be covered by the medical
insurance of my son/daughter/ward, as may be applicable, while those not covered by the said
medical insurance shall be for my account; and I will not hold the School liable for the said
expenses.
5. On the other hand, I trust that the School will:
a. Observe due care to safeguard the students, to the extent reasonably possible, from
COVID 19 exposure; and
b. Comply with the relevant guidelines prescribed by CHED in conducting face-to-face
classes.

Conforme:

We fully understand and agree to the provisions of this Consent Form.

________________________________ ________________________________
Signature above the Name Signature above the Name
of Father/Mother/Legal Guardian of Student

___________________________ ____________________________
Date Date