COVID -19 WAIVER OF PARENT OR GUARDIAN

KNOW ALL MEN BY THESE PRESENTS:

That I, ___________________, Filipino, single (or married), and a resident of

____________________________, hereby acknowledge that I am the parent/guardian of
_________________________, a minor who intends to attend classes at
___________________________

I agree that by committing my child to attend classes as an in person student, I am

voluntarily assuming any and all risks that notwithstanding the School’s best
efforts to implement and require compliance with prevention and mitigating
measures of the National and Local Government, I, my family or my child, may be
exposed to the coronavirus and may become ill with COVID-19 or any of its
mutations, and such exposure and illness may result in personal injury, temporary
or permanent disability, or even death. By voluntarily assuming all the risks that
attach to the on-campus or in person education of my child, I am holding at
__________________________________ free and harmless of any unfortunate
consequence that a COVID - 19 (or any of its mutations) infection may bring
should my child, or any member of my family, contract the same while attending
face-to-face classes at ________________________.

That I am fully aware of the contents of this waiver and I am executing the same
voluntarily and fully aware of the consequences of the same.

IN WITNESS WHEREOF, I have set my hand and signature this ____ day of ______,
2022 at ___________________, Philippines.

SIGNED IN THE PRESENCE OF:

_________________________

_________________________

___________________
Parent/Guardian

REPUBLIC OF THE PHILIPPINES)

____________, )s.s.

SUBSCRIBED AND SWORN to before me this _____ day of ______, 2022 at

_______________, Affiant having exhibited to me her/his government issued ID
issued on ________ at __________.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2022