School of Our Lady of La Salette, Inc.

Mountain View Subdivision, Muzon, CSJDM, Bulacan

Tel No. (044) 815- 4201
Email Address: solsbulacan@yahoo.com.ph

PARENTAL WAIVER AND CONSENT FORM

NAME OF STUDENT: ___________________________________________________________

ADDRESS: _____________________________________________________________________
GRADE & LEVEL: ______________________________________________________________
LIST OF ANY PHYSICAL LIMITATIONS
1. __________________________________
2. _________________________________

ACTIVITY: Performance Task in MAPEH 9 (Performance Task - Social Dance)

LOCATION: Grade 9 rooms 3rd Floor (St, Lucy and OLLS)
DATE & TIME: December 01, 2023 Friday (1:00 -4:00 pm)
CLASS ORGANIZATION: Grade 9 (MAPEH)
FACULTY-IN-CHARGE: T. Emiereta M. Alegiojo
SIGNATURE OF FACULTY-IN-CHARGE:

As the parent or legal guardian of the child named above, I hereby give my full consent and approval
for my child to participate in the activity designated above.
I acknowledge and accept that my child’s participation in this activity is entirely voluntary and all
risk is voluntary assumed by my child and me. I understand that school rule and regulations will be in
effect. I have also ensured that my child understand that it is important for her/his safety, and that all
rules and instructions given by faculty-in-charge are obeyed.
In allowing my child to join this activity, I am giving my full consent for my child’s participation, I
do hereby waive, release and hold harmless The School of Our Lady of La Salette, its faculty -in
charge and administrators for any expense, loss, liability or personal injury that may be incurred in
the normal course of participation in the designated activity .

Parent/Guardian Signature:

Date:

Contact number: