_________________ ELEMENTARY SCHOOL

_________________ District
School ID: _______________
________________________________________
SY 2021 – 2022

PARENT CONSENT AND WAIVER

As the parent /legal guardian of the student named below, I hereby give my full consent
and approval for my child to participate in the internship/limited face-to-face classes to
______________ Elementary School, _______________________________________.
I understand that there are certain health risks or possibilities of injury inherent in
learning process and practice of this program, as well as in travelling and other related activities
incidental to my child’s participation, and I am willing to assume these risks on behalf of my
child. I hereby certify that my child is fully capable of participating in the designated activities
and that my child is healthy and has no physical or mental disabilities or conditions that would
restrict full participation in these activities.

In addition to giving my full consent for my child’s participation, I do hereby waive,

release and hold harmless to Ligaya Elementary School, its administrators for any health risks
that may be suffered by my child in the normal course of participation in limited face- to – face
and the activities incidental thereto, whether the result of negligence or any other cause

Name of the Child: _______________________________________

Home Address: __________________________________________

________________________________________________________
Parent/ Guardian Signature over Printed Name

Date ____________________________________________