STUDENT AND PARENTAL CONSENT WITH WAIVER

_________________
DATE
To Whom It May Concern:

I, ________________ of legal age, and a resident of _______________________________, am

a _________ (year level) _________________
(program) student of Andres Bonifacio College, do hereby execute the following statement:
THAT, I, have qualified (invited/endorsed, recommended) to participate in the
____________________________________( name of activity/competition/seminar) on
______________________________ at________________________________. That I will join and
participate in the above-mentioned activity in my own free will for the purpose of gaining additional
knowledge exposure, and experience in any matter relevant to my program.
THAT, I, ___________________________ of legal age, single/married, and a resident of
______________________ am the parent/guardian of ___________________________ after having
carefully considered that the benefits far outweigh the risks, hereby agree and give my consent to the
participation of my son/daughter/ward ______________________________. I understand that
participation in the activity is entirely voluntary and requires participants to abide by applicable rules,
protocols and standards of conduct, behavior and demeanor during the activity including the period of
travel to and from the venue. With the exercise of due diligence by Andres Bonifacio College, the activity
coordinators, coaches, trainers, advisers, and related parties. I hereby release them from any liability for
eventualities that are beyond their control.
WHEREFORE, we affix our signatures to the aforementioned activity this ____day of_______,
_________ at Dipolog City.

___________________ __________________
Student Parent/Guardian

Signed in the presence of:

____________________ ______________________ HENRY MARK T. CASOCOT. MPA

Instructor Dean DASAS Director