ARELLANO UNIVERSITY

2600 Legarda St. Sampaloc, Manila

CONSENT FORM

I, _______________________ (parent/guardian) of _____________________ (student’s name),

_________ years old, a student of Arellano University - Andres Bonifacio (campus), do hereby give
my consent, willingly and voluntarily, for the participation of _______________________ (student’s
name), to meet their groupmates for their practice in Physical Education & Health 3 on
(date) at (time).

By signing this consent form, I undertake to remind my son/daughter/ward to always act with due
diligence, safety, and care, endeavoring at all times to see to it that his/her conduct during the entire
affair/activity shall establish, maintain and contribute to his/her personal security and protection and
those of the other participants of the activity. By reason of said event, I understand and give consent
to personal information that may be shared to the public for legitimate purposes of the University. I
hold Arellano University, its officers, directors, personnel, free from any and all liability that may
arise from the participation of _______________________ (student’s name), in said event.

_______________________
Parent/Guardian Signature Over Printed name

Conforme:
Kenneth Isaac A. Marzan

_______________________ PE 3 Teacher
Student Signature Over Printed name

(Please attach copy of any valid ID with match signature)