CONSENT FORM FOR THE HYBRID FLEXIBLE AND EXPANDED FACE-TO-FACE COURSE DELIVERY

OF ACADEMIC AND PRACTICAL/LABORATORY CLASSES

I, _____________, ___ ____ years old and a year student at the

College of Marine Engineering hereby acknowledge that:

1. I have been informed of the details of the conduct of HYBRID FLEXIBLE AND EXPANDED FACE-TOFACE
COURSE DELIVERY OF ACADEMIC AND PRACTICAL/LABORATORY, for Bachelor of Science in Marine
Engineering program, and it is subject to the rules and regulations that are issued by the Commission on
Higher Education.
2. I understand the risks associated with the specified mode of course delivery for the said program and agree
that the rules and regulations established for the said program are for the safety and security of the
participants, and thus I agree to obey them including that of the regimental discipline training the BMA is
known in developing mental, physical, and psychological well-being of its cadets thru series of calisthenics
and drills program. I shall adhere to BMA physical requirements in accordance with the approved class
schedules, failure to do so would put me in sanctions according to the academy code of ethics and discipline.
3. I understand that COVID-19 has been declared a pandemic by the World Health Organization, and I recognize
and understand the protocols that are required by BMA are in accordance with the law.
4. I shall be responsible for reporting any history of travel, any exposure to a COVID-19-positive individual, any
symptoms (such as cough, colds, fever, difficulty of breathing, alteration of the sense of smell, taste, and
diarrhea), and the result from any previous test done (RT-PCR or Rapid Antibody test).
5. I agree that prior to participation in the program, medical clearance should be secured, there are no
symptoms relating to COVID-19, and proof of full vaccination should be presented, requirement for
vaccination is in line with the safety and health protocols of CHED and MARINA, IATF-LGU’s.
6. I understand that I may have an elevated risk of contracting COVID-19 simply by being in the laboratory
facility, during transport going to BMA and when going home. Thus, I am responsible to take my personal
safety at all times by wearing face masks and bringing my safety kit and personal necessities.
7. I have been informed that the administration, Ex-O office, and other staff of BMA have implemented
preventative measures intended to reduce the spread of COVID-19. However, given the nature of the virus, I
understand that there may be an inherent risk of becoming infected with COVID19 by proceeding with this
program.
8. I am fully aware that registration with PHILHEALTH or equivalent medical insurance that covers medical
expenses related to COVID-19 is highly encouraged for my own personal protection. In any case, the BMA
shall provide assistance relative to endorsing and reporting any COVID-19 related case/s to the local RHU.
BMA and its employee cannot be held liable for any financial obligations.

IN WITNESS WHEREOF, I have hereunto affixed my signature this day of at

____________________________________.

__________________________________________ ________________
Name and Signature of Student Date

__________________________________________ ________________
Name and Signature of Parent/s or Guardian Date

Home Address:
Telephone Number:
Mobile Number:

SUBSCRIBED AND SWORN TO before me this 12th day of August 2023 in San Miguel, Bulacan, Philippines affiant exhibiting
to me her government issued identification bearing her photograph and signature as competent evidence of her identity.
JOEL P. DELOS SANTOS
Notary Public
9016 De Leon St., Poblacion, San Miguel,Bulacan
pRoll of Attorneys No. 76057
PTR No. 0220433; 01-04-23; San Miguel, Bulacan
IBP Member No. 266835; 01-04-23; Bulacan
MCLE Compliance No. VII-0007715; 07-28-2021
Notarial Commission No. PNC-04-MB-2022
Until 31 December 2023