PARENT’S CONSENT

I, _________________________, Filipino, of legal age, with address at

_____________________________, after having been duly sworn to in accordance with law hereby depose,
state and undertake:

1) I am the parent/guardian of __________________________________, a grade _____ student of the

Basic Education Department in Southwestern University PHINMA (SWU).

2) The Southwestern University PHINMA will be holding a physical activity on

_________________________ at ______________________________. The activity (Provide the title of the
activity and short description of the activity). The school and the department is making sure that existing
rules and regulations as imposed by the Department of Education (DepEd), Local Government of
Cebu City, and the IATF is strictly followed.

3) I hereby affirm and confirm that I have been completely informed of the risks relative to the physical
school activity of my son/daughter/ward, and I freely give my consent for my son/daughter/ward
to participate therein.

4) In view of the foregoing, I will not hold SWU, its affiliate companies, administrators, directors,
officers, assigns, affiliates, employees and representatives, LEGALLY RESPONSIBLE should I, my
son/daughter/ward will be exposed to COVID19, and all consequences and liabilities as a result of
such exposure.

5) I hereby render free and harmless, SWU its affiliate companies, administrators, directors, officers,
assigns, affiliates, employees and representatives, from any and all LEGAL liabilities, claims,
demands, actions, and causes of action, whatsoever arising out of or by reason of my decision to
allow my son/daughter/ward to participate in the said activity.

6) In signing this document, I ACKNOWLEDGE AND REPRESENT that I have read this document and
the contents hereof, have understood it and signed it voluntarily as my own free act and deed; no oral
representations, statements, or inducements, apart from the foregoing written agreement, have been
made; and I execute this instrument fully intending to be bound by the same;

IN WITNESS WHEREOF, I have hereunto affix my signature this ________________,

_____________, Philippines.

_________________________________
Signature over Printed Name