Maryhill College, Inc.

Higher Education Department

Lucena City

REGISTRATION CONFIRMATION FORM

(Note: Only accomplished forms will be recognized as official registry. Maryhill College reserves the right to disapprove incomplete application forms)

Event Title: NSTP Coastal Clean Up Event Date: April 23, 2022
Registration Date: ________________________ Event Location:
 Brgy. Talao-talao, Lucena City

First Name: ________________ Middle Name: ______________ Last Name: ________________

Date of Birth: _______________ Age: ___________ Course: _____________________________

Home Address: ___________________________________________________________________
___________________________________________________________________
Email: ______________________________ Contact No.: _________________________________
Parent’s Contact No.: __________________________

ACKNOWLEDGEMENT OF WAIVER

Upon signing this disclaimer, I hereby confirm that I have voluntarily agreed to join this event
being in the appropriate age and discretion. I am fully aware that Maryhill College shall provide services
related only with facilitation and program management. I shall therefore take full responsibility of my
personal safety and that resulting circumstances that may happen due to personal conduct, negligence,
and even accident before, during, and after the said event shall not bind Maryhill College as well as its
officials or representatives with any liability.

________________________________________ ________________________________________
Registrant’s Signature over Printed Name Date Signed

PARENT/GUARDIAN CONSENT FORM AND LIABILITY WAIVER

To Whom It May Concern:

This is to certify the I/we, the undersigned parents/guardian, have given full consent to my/our
son/daughter, _____________________________, to join the National Service Training Program
Coastal Clean-up to be held on April 23, 2022 at Brgy. Talao-talao, Lucena City.
This is to certify further that MARYHILL COLLEGE as well as its officials or duly authorized
representatives shall not be held liable for any untoward incident beyond control that may happen to
my/our son/daughter in connection with his/her participation to the activities relative to the aforementioned
event. It is expected, however, that a built-in precautions to avoid unnecessary will be done to protect my
son/daughter.
Given this ____ day of ___________________ 2022 at Maryhill College, Lucena City.

________________________________________ ________________________________________
Father’s Signature over Printed Name Mother’s Signature over Printed Name

________________________________________
Guardian’s Signature over Printed Name

Maryhill College, M.L. Tagarao St., Lucena City, 4301 Philippines. Tel. No. (42)373-0165
Email: mc.cte@maryhillcollege.edu.ph Website: www.maryhillcollege.edu.ph