Republic of the Philippines

Department of Education
REGION VI – WESTERN VISAYAS
SCHOOLS DIVISION OF NEGROS OCCIDENTAL
__________________________________________________________________________________________

PARENTAL CONSENT, WAIVER & RELEASE

I/ We
_________________________________________________and_____________________________
____________________, the parents/guardian of
____________________________________________________________________, Filipino
Citizens and with address at
________________________________________________________________-, Talisay City
hereby declare under oath:
1. I/We give full consent to our child
___________________________________________________________________ to join
the 2023 Talisay District _____ Meet as participant/athlete of
__________________________________________ on _______________________, Talisay
City, Neg.
2. I/We truly understands that appropriate and reasonable safety precautions and
measures is given to my child during the activity.
3. It is my/our intent that this waiver of liability, Hold Harmless agreement, and Consent
to the Medical Treatment shall bind members of my family, heirs and assigns and shall
be deemed as a Release, Waiver, Discharge and Covenant not to sue.
4. I/We acknowledge that we understood what is written herein and signed voluntarily.

___________________________________________________________________________
________________
PARENTS/ GUARDIAN’S NAME AND SIGNATURE