Republic of the Philippines

Department of Education
REGION IX, ZAMBOANGA PENINSULA
SCHOOLS DIVISION OF ZAMBOANGA CITY
TICTAPUL NATIONAL HIGH SCHOOL
TICTAPUL, ZAMBOANGA CITY
____________________________________________________________________________________

WAIVER
I, Mr./Mrs. ________________________________, (Father/ Mother) of
________________________________, grade ______ of section __________________,
school year ____________ of TICTAPUL NATIONAL HIGH SCHOOL, appeared personally in
school and agreed to the terms and conditions of the school rules and regulations specially with
regards to the LIVE BIRTH CERTIFICATE(LBC), whereas, LBC should be given as school
requirement.

Failure to comply with the said document, we, the parents of

______________________, waive/ agreed that the written name in the waiver will be the same
name which will be written in the form SF10, and other school documents.

Failure to accomplish with the said document, the school will use the name that appears
in the waiver.

Signed this ______ day of ______________ at Tictapul National High School, Tictapul ,
Zamboanga City.

_________________________
Parent/Guardian Signature over Printed Name

_________________________
Class Adviser

_____________________________
Grade 8 Year Level Curriculum Chair

Tictapul National High School

Tictapul, Zamboanga City
Contact Number: 09171026600
Email Address: tictapulnhs@gmail.com