Republic of the Philippines)

Calamba City ) S.S.

PARENT / GUARDIAN CONSENT FORM for LIMITED F2F CLASSES

I, _____________________, parent/ guardian of __________________, a student of CALAMBA

DOCTORS’ COLLEGE, taking ___________________________, with postal address at
__________________________________________, hereby consent to let my son/daughter named
above, to participate in the Limited Face-to-Face (F2F) Classes for Laboratory Courses.
I acknowledge and agree that:
 COVID-19 is a new disease and that people with underlying medical conditions regardless of age are
at severe risk.
 despite Calamba Doctors’ College good faith in the implementation of the Inter-Agency Task Force,
CHED and DOH guidelines, it is impossible to eliminate the risk that student/s might be exposed to
contracting communicable disease including but not limited to Corona Virus Disease 2019 (COVID19)
or other medical conditions, diseases, or maladies which might include illness, permanent disability,
or death.
 By signing below the undersigned acknowledges that the Student does not have an underlying
medical condition, and that if Student has such underlying medical condition the undersigned will
first obtain written permission from a licensed healthcare professional which will be provided to the
school prior to attendance or participation in limited F2F classes.
 Students are required to present a negative RT-PCR test result prior to attending Limited Face-to-
Face Classes at own cost.
 The undersigned should notify the School if the Student is not feeling well, has COVID-19 symptoms
or have been in contact with anyone with a confirmed COVID-19 diagnosis in the last 14 days and
should not allow the student to go to school and or attend limited F2F classes.
 Student will not be allowed to go to school and to attend or participate in limited F2F classes if they
are subjected by the government to undergo quarantine or isolation.
 Student and the undersigned must comply with any safety or health related rules, terms, or
conditions for participation in limited F2F classes including but not limited to wearing of Personal
Protective Equipment such as face mask, face shield, gown, cap, shoe cover, gloves etc. and bringing
own personal hygiene kit to school.
 Student will comply with the one entry one exit policy as such student will not be allowed to leave
campus to buy food. Thus, food packs and beverage must be prepared for students to bring to
school.
 If Student or Student’s parent or legal guardian observes any unusual, significant hazard during their
presence or participation in the limited F2F classes, Student or Student’s parent or guardian may
remove Student from participation and bring such observation to the attention of the faculty,
immediate supervisor, head or dean or most accessible School employee.
 The School retains the prerogative to deny students or any individual’s entry to school campus due
to probable health hazard to student or other individuals.
 The School reserves the right to implement screening and detection measures including but not
limited to, taking Student's temperature and inquiring about current symptoms, before allowing
Student school entry and participation to limited F2F classes.
 The undersigned knowingly and freely assumes all such risks for Student’s attendance or
Participation in the limited F2F classes.
 After fully and carefully considering all the potential risks involved, I hereby assume the same and
agree to take full responsibility and to release and hold-harmless Calamba Doctors’ College and its
employees, officers, faculty, agents, contractors and concessionaires from and against, all claims and
liability resulting from exposure to disease-causing organisms and objects, such as COVID-19,
 Associated with Student participating in the limited F2F classes, to include, but not limited to
educational, co-curricular, or extracurricular programs.
 I acknowledge and declare that this instrument is hereby made willingly and voluntarily and with full
knowledge of our rights under applicable laws.

IN WITNESS WHEREOF, I hereunder affixed my signature this day of October 2021 at City of
Calamba, Province of Laguna, Philippines.

(Parent’s/Guardian’s Signature over Printed Name) Contact number

SUBSCRIBED AND SWORN to before me this day of October 2021 at City of Calamba,
Province of Laguna, Philippines, and exhibiting to me her
Issued on at .WITNESS MY
HAND AND SEAL, on the date and place first above written.

Notary Public

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Series of 2021