REPUBLIC OF THE PHILIPPINES )

Davao City ) S.S.

x----------------------------------------------x

JOSE MARIA COLLEGE FOUNDATION, INC.

Philippine-Japan Friendship Highway Sasa, Davao City, 8000

INFORMED CONSENT AND WAIVER OF LIABILITY FOR FLEXIBLE LEARNING

AND FACE-TO-FACE ACTIVITIES

By signing this document, I,

________________________________________________ as the parent or legal
guardian of __________________________________________, hereby give my
informed consent and concurrence to the following:

1. Jose Maria College Foundation, Inc. (JMCFI) shall implement strict health
standards and protocols to reduce the spread of COVID- 19 during the conduct of
limited face-to-face activities. However, this is not a guarantee that the students
will not be infected by COVID-19 which may result in illness or death.

2. I understand that my child/ren’s in-person attendance in school will include

associating with teachers, fellow students 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.

3. I acknowledge that my child/ren’s participation in this activity is completely

voluntary. While there remains the risk of possible COVID- 19 transmission to
my child/ren, and to the members of my household, I freely assume the said risk
and I permit my child/ren to attend school under this activity.

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

5. I confirm that my child/ren currently has none of those symptoms, and is in good
health. I will not allow my child/ren to physically go to school to attend classes if
my child/ren or any member of my household develops any of the said symptoms
or any other symptoms of illness that may or may not be related to COVID-19.

6. I will also inform the school and not allow my child/ren to attend face-to-face
classes if my child/ren or any of my household members tests positive for
COVID-19. My child/ren and I, with my household members, will follow the

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 required health and safety protocols and procedures adopted by the school and
our community.

To the extent allowed by law and rules, I hereby agree to waive, release, and
discharge any and all claims, causes of action, damages, and rights against JMCFI
and its officials and personnel relative to the conduct of the activity.

With full understanding that, I – on behalf of myself, my household members, and my

child/ren – hereby freely and voluntarily give my consent to my child/ren’s participation
in the activity for AY 2022-2023. I also attest that I had sought the views of my child/ren
and he/she/they has/have expressed willingness to participate in the activity.

7. I declare that the release, waiver of liability for flexible learning and quitclaim
hereby given is made willingly and voluntarily, with full knowledge of our rights
under the law.

IN WITNESS WHEREOF, I hereby have hereunto set my hand this

_____________, 2022 in Davao City, Philippines.

____________________________________________________
SIGNATURE ABOVE PRINTED NAME OF
STUDENT’S PARENTS/GUARDIANS

DATE SIGNED: ______________

SUBSCRIBED AND SWORN TO before me this _________________, 2022 in

Davao City, Philippines, affiant is exhibiting to me his/her competent evidence of
identity.

WITNESS MY HAND AND SEAL.

Doc No. ______;

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

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