STUDENT INFORMED CONSENT
1. I am a student of Malayan Colleges Mindanao (MCM) and I understand that I was given the option
to attend either online or remote classes, or limited face to face, but I have voluntarily chosen to
attend limited face to face classes offered by MCM in accordance with CHED, DOH and IATF
guidelines.
2. I understand and agree to comply with MCM requirements pursuant to CHED and DOH, IATF and
other government issuances including full vaccination for those attending limited face to face
classes. Students attending such classes are required to be fully vaccinated at least two (2) weeks
prior to the start of the term.
3. I understand and acknowledge that MCM has put in place and is strictly implementing protocols,
safety rules and precautions in order to mitigate and control the spread of COVID-19 within MCM,
pursuant to IATF, DOH, CHED and other government issuances on COVID-19.
4. I understand that MCM, in implementing such health and safety protocols, is exercising the diligence
required to safeguard the health and safety of its students including but not limited to: requiring the
submission of health declarations; regular and proper disinfection of rooms and facilities; providing
adequate ventilation; implementation of the required distances for social distancing in classrooms,
canteen and school facilities; proper handwashing and hand sanitizing among students and
employees; cyclical shifts for limited face to face classes; limiting the mixing of students between
classes or in the use of facilities within the campus; and other policies to help prevent and control
the spread of COVID-19.
5. I acknowledge having read and understood such protocols, rules and precautions and undertake to
strictly comply with such policies, which may include, but are not limited to: accomplishing required
health declarations; mandatory wearing of face masks (and other PPE required, if any); proper hand
washing and hand sanitizing; observing social distancing; and strictly observing the latest advisories
issued by MCM to supplement existing protocols on COVID-19. I understand that failure to comply
with these rules and precautions is a violation of the MCM’s policies and may possibly subject me
to sanctions under MCM policies.
6. I also acknowledge that the nature of the MCM campus, buildings or facilities limits MCM’s ability
to control students and visitors on campus despite the strict implementation of health and safety
protocols. I recognize that MCM, despite health and safety protocols being implemented, cannot
totally eliminate all potential sources of COVID-19 infection.
7. I understand and acknowledge that it is my responsibility to ensure that I do not put others at risk of
exposure to COVID-19 by following MCM’s health and safety protocols. I undertake to wear face
masks (and other PPE required, if any) within the school premises at all times, exercise proper
handwashing/sanitizing, and submit the required health declarations. In the event that I am not
feeling well, or when I or any member of my household develops any of the said symptoms or any
other symptoms of influenza-like illness that may or may not be related to COVID-19, I will not
attend my classes or enter school premises.
8. I recognize that given the nature of COVID-19, it is not possible to fully list each and every
individual risk of contracting COVID-19. I confirm that I am aware and understand all information
on COVID-19 that I may need to determine the risks associated in returning to the University/School
campus and to make an informed assumption of those risks in choosing the limited face to face
option.
9. I also declare that I am registered with Philhealth, which is required for students to attend limited
face to face classes. If not, I undertake to register with Philhealth and submit proof to MCM before
I enroll for the term.
10. By signing this agreement, I acknowledge the contagious nature of COVID-19 and the fact that it
may be difficult to identify all possible carriers of the virus, and the inherent risks of possible
exposure to COVID 19.
11. I voluntarily assume the risk and responsibility in choosing to enroll and attend limited face to face
classes including possible exposure to COVID-19 despite the MCM’s implementation of health and
safety protocols.
My signature below indicates that I am at least eighteen years of age and that I have read and understand
the above statements and intend to be bound by its terms. (If not of legal age: The signature of my
parent or guardian signifies that I and my parent/guardian understand the above statements and intend
to be bound by its terms.)
JAEZON ZHACH P. SANTILLANA
____________________________
Student Printed Name and Signature
GLICELYN P. SANTILLANA
__________________________________
Parent or Guardian Printed Name and Signature
March 22, 2022
Date: _______________________
March 22, 2022
Date: _______________________
Acknowledged receipt by:
OSS personnel & Date received
CHSW personnel & Date received
For any concern or clarification, you may contact studentservices@mcm.edu.ph or 0998 595 0023.
*Please email this form once filled out to the above email address to be acknowledged.