Guihulngan City Campus
COLLEGE OF ARTS AND SCIENCES
SCIENCE DEPARTMENT
PARENT’S WAIVER AND CONSENT FORM
NOTE: Each student is required to complete this form before he/she is allowed to participate in
the activity.
Name of Student: ______________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
ACTIVITY DETAILS:
Title of Activity: _______________________________________________________________________
Nature & Purpose of the Activity: _________________________________________________________
Place of Activity: ______________________________________________________________________
Date of Activity: _______________________ Time Started: __________ Time Ended: __________
PARENT’S WAIVER & CONSENT:
I,
_________________________________________________,
parent
of
_____________________________________________ , hereby allow my son/daughter to go and
participate in the __________________________________________ . In any event where illness or
accident occurs, I hereby authorized the adviser(s) and chaperon(s) to take the necessary actions
as they may be deemed fit.
Furthermore, I hereby absolve the company/agency/firm or any person concerned from
any criminal or civil liability for the illness or accident befalling on my son/daughter except in
the case where the accident occurred out of negligence of the company/agency/firm or person
concerned.
I fully agree to waive any responsibility on the part of NORSU-Guihulngan City
Campus, the Science Department, and the Course/Subject Instructor in case of any untoward
incident that may happen to my son/daughter in the duration of the event.
Signed
this
_________
day
of
__________________
,
20_____
,
at
_____________________________________.
________________________________________
(Signature above Printed Name of Parent/Guardian)
NOTE: Attach one (1) copy of your parent/guardian’s valid ID (front & back). Signatures should coincide with each
other. (This attachment is only applicable to Parent’s Waiver & Consent.)
Guihulngan City Campus
COLLEGE OF ARTS AND SCIENCES
SCIENCE DEPARTMENT
STUDENT LIABILITY WAIVER and
INFORMED CONSENT AGREEMENT FORM
NOTE: Each student is required to complete this form before he/she is allowed to participate in
the activity.
Name of Student: ______________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
College: _______________________________
Course & Year: _________________________
Subject Code: __________________________
Class Schedule: _________________________
Subject Descriptive Title: _______________________________________________________________
ACTIVITY DETAILS:
Title of Activity: ______________________________________________________________________
Nature & Purpose of the Activity: ________________________________________________________
Place of Activity: ______________________________________________________________________
Date of Activity: ______________________ Time Started: __________ Time Ended: __________
STUDENT LIABILITY WAIVER & INFORMED CONSENT:
I, ___________________________________________, of legal age, currently residing at
_____________________________________________ , hereby agreed to participate in the
__________________________________________ Event .
I understand that the event may be held over public roads & facilities open to the public
during the event & upon which hazards are to be expected. I understand that running/walking
in an event that is organized as a Virtual Activity where I run/walk on my own, at a time of my
choosing, in a location & route of my choosing, is a potentially hazardous activity, which could
result in injury, illness, or even death. I acknowledge that I am participating in the activity by
my own free will & at my own personal risk. I agree to follow the rules of the road.
I acknowledge that it is my responsibility to understand the risks & determine whether I
am physically fit to safely complete this event and the precautions I should take.
I understand, acknowledge, and agree that by committing to participate in this activity, I
voluntarily assume liability and responsibility for any potential risks that may be associated
with participation in such activity.
I have carefully read this Liability Waiver & Informed Consent Agreement Form and as
a participant and that I understand and agree to its terms.
Signed
this
_________
day
of
__________________
,
20_____
,
at
_____________________________________.
___________________________________
(Signature above Printed Name of Student)
NOTE: Attach one (1) copy of your parent/guardian’s valid ID (front & back). Signatures should coincide with each
other. (This attachment is only applicable to Parent’s Waiver & Consent.)