PARENT’S CLEARANCE AND WAIVER FORM

This is to certify that I am allowing son/daughter _______________________ to join the

Community Service for NSTP subject, a coastal clean- up which will be held at Silliman Beach
on Saturday, September 17, 2022 with the THEME : “ WE CLEAN ON- for our Ocean and for
Each Other”. This activity is part of

It is understood that the above name will follow the safety protocols needed to avoid any
unwanted incident or transmitted infection, specifically the ongoing spreading of COVID’19 in
the province.

I fully agree to waive any responsibility on the part of Asian College Dumaguete in case of any
untoward incident that may happen to the Student in the duration of the said activity.

_________________________________
Signature above printed name of student

_____________________________________
Signature over printed name of parent/guardian

1. In the event that a parent cannot sign the waiver form, it must be signed by the
legitimate guardian, as evidenced by the letter of guardianship on file.
2. This document must be dated, signed and submitted before the date of the activity. One
copy shall be given to the DPD department, while the other copy must be kept by the
parent/guardian.

VISION MISSION CORE VALUES

“ To be the leading educational “To educate and develop globally Self-Leadership
Institution of choice dedicated to the competitive future teachers” Integrity
Success of its graduates” Academic Excellence