PARENTAL CONSENT AND WAIVER FORM

I,____________________________grant
permission
for
my
daughter,
__________________________, to participate in the school activity of visiting center. This
activity will take place under the guidance and direction of the faculty of College of
Allied Medical Sciences University of Batangas.
Description:
Location
Date
Time
Leave
Return

:
:

St. Patrick Medical Hospital

October 03, 2016
:
:

9:00
11:30

I, as parent and/or legal guardian, remain legally responsible for any personal
actions taken by the above named participant.
I agree on behalf of myself, my child name herein, or our heirs, successors and
assigns, to hold harmless and defend University of Batangas, its officers, directors
and agents, employees, faculty, or representatives associated with the event, from
any and all actions, claims, demands, damages, costs, expenses and all
consequential damage arising from or in connection with my child attending the
event or in connection with any illness or injury or cost of medical treatment in
connection therewith.
In signing the Parental Consent and Waiver, I am not relying any oral or written
representation or statements made by the university, andt its officers, directors and
agents, employees, faculty or representatives associated with the event, to induce
me to permit my student to join the activity, other than those set out in this Consent
and Waiver.
I have read and understand the terms of this consent and waiver, and recognize
that it is binding upon me.

________________________________
Parent/Guardian over Printed Name
Home Address:_____________________________________
Contact No(s): _____________________________________

__________________________
Date

PARENTAL CONSENT AND WAIVER FORM

I,____________________________grant
permission
for
my
daughter,
__________________________, to participate in the school activity of visiting center. This
activity will take place under the guidance and direction of the faculty of College of
Allied Medical Sciences University of Batangas.
Description:
Location
Center
Date
Time
Leave
Return

Kaleidoscope

October 17, 2016

:
:

Therapy

and

Learning

8:00
10:30

I, as parent and/or legal guardian, remain legally responsible for any personal
actions taken by the above named participant.
I agree on behalf of myself, my child name herein, or our heirs, successors and
assigns, to hold harmless and defend University of Batangas, its officers, directors
and agents, employees, faculty, or representatives associated with the event, from
any and all actions, claims, demands, damages, costs, expenses and all
consequential damage arising from or in connection with my child attending the
event or in connection with any illness or injury or cost of medical treatment in
connection therewith.
In signing the Parental Consent and Waiver, I am not relying any oral or written
representation or statements made by the university, andt its officers, directors and
agents, employees, faculty or representatives associated with the event, to induce
me to permit my student to join the activity, other than those set out in this Consent
and Waiver.
I have read and understand the terms of this consent and waiver, and recognize
that it is binding upon me.

________________________________
Parent/Guardian over Printed Name

__________________________
Date

Home
Address:_____________________________________
Contact No(s): _____________________________________