PARENT/GUARDIAN CONSENT FORM

TO WHOM IT MAY CONCERN:

This is to certify that I allowed my son / daughter to join the 2016 ENGLISH CAMP.

DATE OF ACTIVITY: NOVEMBER 26, 2016

PLACE OF ACTIVITY: ROSA L. SUSANO-NOVALICHES ELEMENTARY SCHOOL

NAME OF SON/DAUGHTER
GRADE & SECTION
NAME OF SCHOOL

Thank you very much!

Yours truly,

__________________________________ APPROVED:

NAME OF STUDENT __________________________

(Signature Over Printed Name) NAME OF PARENT / GUARDIAN

(Signature Over Printed Name)

STUDENT WAIVER

I, ______________________________________________(NAME) presently enrolled in

__________________________________________________________________(NAME OF SCHOOL)
____________________________________________(GRADE & SECTION) present myself to join the 2016
ENGLISH CAMP as part of our school/student activity and do hereby pledge that:

1. I will obey the rules and regulations promulgated, enforced by the officials of the English Coordinators
Association of Quezon City for the protection and safety of all;

2. That I hereby waived and renounce my rights to all damages, hospitalization, and the like and I will not
hold the school of MUST responsible for any misfortune, injury, or accident be slight or serious, that may happen
in connection with the activities or requirements. The cause of which will be attributable to my acts of my
disobedience, negligence, and the offense of my heading to advice, warning, precaution, and safety rules that
were read to me by my adviser before the start of the activity. That the content of this waiver was read and
explained to me before I affix my name and signature this ______ day of ______________freely and voluntarily.

Thank you very much!

Yours truly,

APPROVED:

__________________________ __________________________

Name of Student Name of Parent/ Guardian

(Signature-Over-Printed Name) (Signature-Over-Printed Name)