FORM 4

PAMBANSANG KAPISANAN NG MGA KABATAAN SAMAHAN NG AGHAM

(PHILIPPINE SOCIETY OF YOUTH SCIENCE CLUBS), Inc.
703 West Mansions Condominium, Zamboanga St., Brgy. Nayong Kanluran, 1104 Quezon City

25 – 28 August 2023 | Mindanao

NYSTESC WAIVER FORM

I, ____________________________________, hereby permit my son / daughter,

Name of Parent/Guardian
___________________________________, to participate in the 2023 National Youth
Name of Student
Science, Technology, and Environment Summer Camp on August 25 to August 28, 2023.
I have ensured that my son/daughter understands that it is important for his/her safety that
all rules and instructions given by the event organizers shall be obeyed. I hereby agree
that I will not hold the organization and the organizers responsible for any expenses, loss,
personal, injury, or accident that may happen beyond their control.

Signature over Printed Name of Parent/Guardian

Date Signed