Page 1 of 1

UNIVERSITY OF ANTIQUE
Mayor Santiago A. Lotilla St., Sibalom, Antique www.antiquespride.edu.ph

036-543-8161 ua@antiquespride.edu.ph ISO 9001:2015 Certified

PARENT’s CONSENT FORM

________________
TO WHOM IT MAY CONCERN:

This is to certify that I allow my son/daughter/ward _______________________________ enrolled in _________________________

(course/year/section) to join the Community Immersion/ Extension for the duration of the course Civic Welfare Training Services
conducted this Second Semester, Academic Year 2022-2023, conducted at ___________________________________________.

_________________________________
(Printed name and signature of parent)
Please attach photocopy of valid ID

Student’s Waiver Form

I, _________________________________________ (name) currently enrolled in ___________________________________

present myself to join the CWTS Community Immersion/Extension as part of our school / student activity and do hereby pledge that:

1. I will obey and abide the rules and regulations promulgated and enforced by the officials of the University of Antique, through
my course instructor for the protection and safety of all during the conduct of said activity/ies;
2. That I will not hold the University or its representative responsible for any misfortune, injury or accident caused by force
majeure beyond the control of the adviser, provided the adviser/s exercised precaution like a good parent for the students;
3. That I hereby waive and renounce my rights to all damages, and hospitalization claims and the like against the University or
its representatives or hold the same responsible for any injury or accident, be it slight or serious, that may happen in connection
with the conduct of said activities, the cause/s of which are attributable to my acts of disobedience, negligence or failure to
heed the advice, warning, and precautionary rules given by the adviser/read and discussed in class/ posted in the LMS prior to
the onset of the activity.

That the content of this waiver was read and explained to me before I affix my name and signature this ___ day of _______________,
2023 and that I am affixing my signature freely and voluntary.

Very truly yours, With my consent:

_________________________________ _________________________________
(Student’s Signature over printed Name) (Parent’s Signature over printed Name)
Please attach photocopy of Student ID

PO-FM-008 Transforming Lives, Building Communities. REV.2/08-11-20