BASIC EDUCATION DEPARTMENT

Corner P. Lopez & Magallanes Sts., Cebu City 6000 Philippines

Tel.No. (032) 253 7900 loc. 356

UNDERTAKING AND WAIVER

I, _______________________________________________, the parent or guardian of

______________________________ of ____________________ (Grade/ Year level),
hereby acknowledge that I have been informed of the details of the
conduct of the Basic Education Enrolment this coming Academic Year 2022-
2023. I am also aware that we are asked to submit the student’s COVID -19
vaccination card during enrolment and if the event if the student is
unvaccinated, we are asked to sign this waiver form.

I understand that the University of San Jose-Recoletos (USJ-R) shall implement

minimum public health standards set by the government to minimize the risk
of the spread of COVID-19, but it cannot guarantee that my child will not
become infected with COVID-19, given that COVID-19 is highly contagious.

I understand that my child’s in-person attendance in school for the

Academic Year 2022-2023 will include associating with teachers, fellow
learners and school personnel, and other persons inside and outside of the
school that may put my child at risk of COVID-19 transmission,
notwithstanding the precautions undertaken by the school.

I acknowledge that my child’s participation in face to face classes is

completely voluntary. While there remains the risk of possible COVID-19
transmission to my child and the members of my household, I freely assume
the said risk and I permit my child to attend the face to face classes.

I am aware that symptoms of COVID-19 include, but are not limited to, fever
or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or
body aches, headache, loss of taste or smell, sore throat, congestion or
runny nose, nausea, vomiting, and diarrhea.

I hereby undertake if my child exhibits any COVID-19 symptoms mentioned

above and if my child tests positive for COVID-19 or have been in close
contact with a COVID-19 suspect or confirmed person, I will not allow my
child to attend the face to face classes and stay at home instead. My child
will follow the required health and safety protocols and procedures adopted
by the University and our community.

In accordance with the law, issuances, rules, and regulations, I hereby freely
and voluntarily declare, discharge, release and waive the University of San
Jose-Recoletos and all its religious and administrative officers from all claims
and liabilities whatsoever relative to the conduct of the activity.

_______________________________________
Parent/ Guardian
Electronic signature over printed name

“BREAKING BARRIERS, EMPOWERING LIVES”