KOLEHIYO NG LUNGSOD NG DASMARIÑAS

OFFICE OF THE VICE PRESIDENT FOR ACADEMIC AFFAIRS

Institute Of Student Affairs, Character Education, And Citizenship
ISACEC FORM 4
OFF-CAMPUS ACTIVITY

FOUNDATION WEEK CELEBRATION CONSENT/WAIVER

STUDENT INFORMATION

_________________________ _________________________ _____ __________________________________

Last Name First Name M.I Course, Year, and Section

______________________________________________________________ _________________________
Address Student Number

Contact Number: _______________________

Class Adviser: _________________________________________

Medical condition/medication of student (if any) Academics

Non-Academic
____________________________________________________________________

Sports/Cultural Arts

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PARENT/GUARDIAN CONSENT/WAIVER FORM
This is to certify that I have full knowledge of and permission for my son/daughter/foster child
to join and participate in:

Title of Activity: FWC: MR. AND MS. KLD / ACQUAINTANCE PARTY

Date & Time of the Activity: SEPTEMBER 21, 2023, 1:00PM-9:00PM

Place of Activity: DASMARINAS CITY ARENA

I concur and agree with the rules, policies & regulations being implemented by the concerned
organizers.

I/We voluntarily waive our rights to claim against the concerned authorities and school of whatever
nature, be it civil, criminal, or administrative should any untoward incident befall our son/daughter/ward in the
course of his/her participation and during the travel to and from the said event.

__________________________________ _______________________ _____________________

Name & Signature of Parent/Guardian Date Contact Number

Waiver for Working Students / Students who reside outside Dasmarinas

I am certifying that my child ________________________________________________ will leave at an

earlier time, specifically at __________________ and will not finish the Acquaintance Party because of
__________________________________________________________________.

I voluntarily waive my rights to claim against the concerned authorities and school of whatever nature, be it
civil, criminal, or administrative should any untoward incident befall my child in the course of his/her early
departure from the said event.

__________________________________ _______________________ _____________________

Name & Signature of Parent/Guardian Date Contact Number

Building the foundation for the Dasmarineños

kldstudentaffairs@gmail.com l College Building 1, Upper Ground Floor 1106 l Brgy. Burol Main, City of Dasmarinas, Cavite, Philippines 4114