BATAAN PENINSULA STATE UNIVERSITY

CENTRAL OFFICE
Capitol Compound, Tenejero, City of Balanga 2100 Bataan
INSTITUTIONAL STUDENT PROGRAMS AND SERVICES
Email: studentprogramservices@bpsu.edu.ph

PARENTAL CONSENT FORM

October 24, 2023

Dear Parent/Guardian

Starting on October 28, 2023, as part of our course subject BPED0613 / ESSM0613 Swimming
and Aquatics and PATHFIT3 Aquatics ,we will be having our swimming class at Villa Amanda
Resort and Restaurant, Abucay, Bataan

The aims of the activity are:

A. As well as being fun, swimming is a great way to keep fit and make friends
B. Swimming is a healthy activity that you can continue for a lifetime.
C. Swimming is a low-impact activity that has many physical and mental health benefits
D. Personal safety/ provide the ability to survive in the water.

Activity Details:

For BPED0613 and ESSM0613 SWIMMING AND AQUATICS

PARTICIPANTS ACTIVITIES Target Dates

October 28, 2023
BPED 2ND YEAR 2A BASIC SKILLS
Every Wed 12:00- 3:00 PM FREESTYLE November 6-7, 2023

MIDTERM EXAM November 13-14

BPED 2ND YEAR 2B BACKSTROKE November 20-21,2023
Every Monday 1:00-4:00PM November 27- 28, 2023

BREASTSTROKE December 4-5, 2023

BSESS FSM 2ND YEAR December 11-12, 2023
Every Tuesday 6:30-9:30 AM
BUTTERFLY JANUARY 2024 ONWARDS
DIVING
SURVIVAL SKILLS

Our Vision Our Mission

A leading university in the Philippines recognized for its proactive To develop competitive graduates and empowered community members by providing relevant, innovative
contribution to Sustainable Development through equitable and inclusive and transformative knowledge, research, extension and production programs and services through
programs and services by 2030. progressive enhancement of its human resources capabilities and institutional mechanism.
 BATAAN PENINSULA STATE UNIVERSITY
CENTRAL OFFICE
Capitol Compound, Tenejero, City of Balanga 2100 Bataan
INSTITUTIONAL STUDENT PROGRAMS AND SERVICES
Email: studentprogramservices@bpsu.edu.ph

For PATHFIT 3 AQUATICS

PARTICIPANTS ACTIVITIES Target Dates

October 27, 2023
BSF 2 BASIC SKILLS November 10, 2023
Every Friday 7:30-9:30

BTLED 2 MIDTERM EXAM November 17

FREESTYLE November 24,2023
Every Friday 9:30-11:30 November 27- December 01,
2023

BACKSTROKE December 8, 2023

December 15, 2023

OTHER WATER ACTIVITIES JANUARY 2024 ONWARDS

FUN WATER GAMES
AQUA ZUMBA

The venue is conducive for the swimming class/ lesson and will secure the safety of the
students.

Mobility of Students

The students will shoulder the transportation expenses.

General House Rules

1. Students will have to wear proper swimming attire

2. Students can bring their own food for lunch, or snacks.
3. Students shall bring with them their filled-up parental consent form signed by their
guardians/parents

For further information about the activity, please contact:

Yours sincerely,

JANICE ABISTADO GALLARDO, MPES

Instructor

Noted:

ALONZO L. MORTEJO, PhD

OIC- Dean of Instruction

Our Vision Our Mission

A leading university in the Philippines recognized for its proactive To develop competitive graduates and empowered community members by providing relevant, innovative
contribution to Sustainable Development through equitable and inclusive and transformative knowledge, research, extension and production programs and services through
programs and services by 2030. progressive enhancement of its human resources capabilities and institutional mechanism.
 BATAAN PENINSULA STATE UNIVERSITY
CENTRAL OFFICE
Capitol Compound, Tenejero, City of Balanga 2100 Bataan
INSTITUTIONAL STUDENT PROGRAMS AND SERVICES
Email: studentprogramservices@bpsu.edu.ph

Activity Risks and Insurance

As part of the institutional Programs and Services being provided by our university, each
student is covered by the Insurance Policy during off-campus activities which covers the following
benefits:

Consent
By signing this form, I agree that:
 I have read all of the information contained in this form in relation to the activity (including
any attached material) and I am aware of the coverage of personal accident insurance for
students.

 I give consent for my son/daughter, _____________ in class _____________________________

< insert college and program >, to participate in the < insert name > of activity> activity on
<insert date of activity>.

 I will pay the costs detailed in this consent form for my son/daughter’s participation in the
activity.

 In the event of an accident or illness, the personnel in charge may obtain or administer any
medical assistance or treatment my son/daughter may reasonably require.

 I accept liability for all reasonable costs incurred by the institution obtaining such medical
assistance or treatment (including any transportation costs).

 I have provided the institution with all relevant details of my son/daughter’s medical or
physical needs on enrollment and where relevant have updated this information.

Parent/Guardian’s Name:

__________________________________
SIGNATURE OVER PRINTED NAME

In case of emergency, kindly contact this number:

___________________________________________

Our Vision Our Mission

A leading university in the Philippines recognized for its proactive To develop competitive graduates and empowered community members by providing relevant, innovative
contribution to Sustainable Development through equitable and inclusive and transformative knowledge, research, extension and production programs and services through
programs and services by 2030. progressive enhancement of its human resources capabilities and institutional mechanism.