PARENT/GUARDIAN PERMISSION FORM FOR YOUTH ACTIVITY PARTICIPATION

Date: ________________________

Dear Parent or Guardian:

_____________________________ (name of child/youth) is eligible to participate in a City Government of

Zamboanga through the Local Youth Development Council and Local Youth Development Office organized offsite/3-
DAY (2 NIGHTS) activity requiring travel and nights away from the home and outside of the center. This activity will
take place under the guidance and supervision of Local Youth Development Council members and Local Youth
Development Officer staffs. A brief description of the activity follows:

Name of event: Youth Peace Camp 2023

Destination: Manicahan National High School, Manicahan, Zamboanga City

Designated Supervisor of Activity and Contact Information: Ms Husna Hayudini (Youth Peace Camp
Coordinator); 09161354984

Date and Time of Departure: July 27, 2023, Thursday, 8:00 am

Date and Anticipated Time of Return: July 29, 2023, Saturday, 2:00 pm

Method of Transportation: City Government Bus

What youth should bring: Personal items such as: clothes enough for 3 days (2 nights), one cultural attire, towel,
hygiene kit – toothbrush, toothpaste, soap, comb, maintenance medicine if applicable

If you would like your child to participate in this event, please complete, sign and return the following statement of
consent and release of liability. As a parent or legal guardian, you remain fully responsible for the actions and conduct
of your child.

(Detach and Return)

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**************************STATEMENT OF CONSENT***************************

I hereby consent to participation by my child, _____________________________ (name), in the event described

above. I understand that this event will take place away from and that my child will be under the supervision of the
designated adults on the stated dates. I further consent to the conditions stated above on participation in this event,
including the method of transportation.
In consideration of my child being allowed to participate in this 3 day (2 nights) youth activity, I agree to indemnify
and hold harmless City Government of Zamboanga, the Local Youth Development Council, and Local Youth
Development Office, their employees, agents and representatives, including volunteer and other drivers, from any and
all claims, including negligence, arising from or relating to my child’s participation in activity. The indemnification
and hold harmless agreement do not apply to claims for intentional misconduct or gross negligence.

________________________________________ _______________________________________
(Print Parent/Guardian’s Name) (Date)
________________________________________ _______________________________________
(Parent/Guardian’s Signature) (Contact Information)

Please mention any special medical needs or allergies of your son/daughter.

________________________________________________________________

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