Republic of the Philippines

ALBAY YOUNG FARMERS ORGANIZATIONS INC.

Province of Albay

FORM 1

WAIVER & HEALTH ATTESTATION

A. HEALTH ATTESTATION

THIS IS TO ATTEST that the participant, whose information appears below, is physically fit to
participate and is capable of participating in the AGAPAY ALBAY: MAYON RESPONSE
PSYCHOSOCIAL ACTIVITY to be held on June 29, 2023 at Taladong ES Evacuation Center.

In lieu of medical certificate signed by a medical doctor, this attestation proves that the above-
mentioned player has no physical or mental impairment that would affect his participation in the event.

B. LIABILITY RELEASE

In consideration of the acceptance of my participation in AGAPAY ALBAY: MAYON

RESPONSE PSYCHOSOCIAL ACTIVITY to be held on June 29, 2023 at Taladong ES Evacuation
Center.

I hereby waive, release, and discharge any and all claims for damages for personal injury, property
damages or which may hereafter occur to me as a result of participation in the said event.

This release is intended to discharge in advance the Organizers, its officials, officers, employees,
volunteers and agents from all claims or damages, demands of actions whatsoever in any manner arising
from or growing out of my participation in, or while traveling to and from, the abovementioned activity.

I have full knowledge of the risks involved; thus, my health attestation further certifies my readiness
to participate. Furthermore, I hereby give my consent to the use of my name and photograph and/or
videotape taken of me for publicity purposes.

It is further understood and agreed that this waiver, release and assumption of risk is to be binding
on my heirs and assignees.

C. PARENTAL CONSENT (FOR 18 YEARS OLD AND BELOW ONLY)

I give consent for my child to participate in the activity, and I execute the above liability release on
their behalf. I have read and understood the foregoing liability release and parental consent form, and agree
to all of its terms and conditions.

MAIN OFFICE: 2/F Ninong’s Hotel, Governor Locsin corner Ma.Clara Street, East Washington, Legazpi City, (Albay)
EMAIL ADDRESS: albayyoungfarmersprogram@gmail.com
CONTACT NO.: +63 967 314 5603
 Republic of the Philippines
ALBAY YOUNG FARMERS ORGANIZATIONS INC.
Province of Albay

ACKNOWLEDGEMENT

Republic of the Philippines )

City of Legazpi ) s.s.
Province of Albay )

Before me this 29th day of June 2023, at the place above stated, personally appeared the
following:

Name Government Issued ID Date/Place Issued Signature

BARCELON, Joshua Carl
DAGTA, Angeline
WEE, Daniel Kim Soon
VIBAR, John Paul
BAEZA, Job
PADILLA, Rodel
HILARIO, Jesalve
HILARIO, Joann
MIRANDO, Edelyn
PAREJA, Rashiel Ann
TIDMA, Angelo Joseph
TAGOB, Honeylette
ABANE, Jeffrey
LORAYES, Vhinz Kenneth
REALES, Angel Kuh
ALILITA, Jasmin
ALAURIN, Danica
AGRIPA, Mark
MARQUEZ, Gracelyn
ARCINUE, Antonette
MONTOJO, David Samuel
VALLADORES, Hannah
ROSALES, Karl
ABEJURO, Eddzhen
ASEJO, Edmar
BENASA, John Earl
REYES, Darius
MARCO, John Peter
MADRILEJOS, Ron
QUIJENCIO, Darwin
CANDIDATO, Aldrin

MAIN OFFICE: 2/F Ninong’s Hotel, Governor Locsin corner Ma.Clara Street, East Washington, Legazpi City, (Albay)
EMAIL ADDRESS: albayyoungfarmersprogram@gmail.com
CONTACT NO.: +63 967 314 5603
 Republic of the Philippines
ALBAY YOUNG FARMERS ORGANIZATIONS INC.
Province of Albay

Known to me to be the same persons who executed the foregoing agreement and
acknowledged to me that the same is their free voluntary act and deed.

This instrument consists of three (3) pages including this page upon which the
acknowledgement is written, duly signed by the parties and their witnesses on each of every pages
hereof.

WITNESS MY HAND AND SEAL.

NOTARY PUBLIC

Document No. ___

Page No. ___
Book No. ___
Series of 2022

MAIN OFFICE: 2/F Ninong’s Hotel, Governor Locsin corner Ma.Clara Street, East Washington, Legazpi City, (Albay)
EMAIL ADDRESS: albayyoungfarmersprogram@gmail.com
CONTACT NO.: +63 967 314 5603