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    Student Undertaking, Waiver and Statement of Parental Consent

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    This document is a student undertaking, waiver, and statement of parental consent form for a student to participate in a Leadership Development Program. It outlines 7 conditions the student must agree to, including taking responsibility for their safety, following rules to prevent injury, ensuring they are physically able to participate, and obtaining parental consent. The student and parent must both sign to confirm their agreement to the conditions and for the student to participate in the event.

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    Student Undertaking, Waiver and Statement of Parental Consent

    Uploaded by

    Green
    43 views1 page
    This document is a student undertaking, waiver, and statement of parental consent form for a student to participate in a Leadership Development Program. It outlines 7 conditions the student must agree to, including taking responsibility for their safety, following rules to prevent injury, ensuring they are physically able to participate, and obtaining parental consent. The student and parent must both sign to confirm their agreement to the conditions and for the student to participate in the event.

    Original Title

    NAW2018-DAY-3-WAIVER

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    This document is a student undertaking, waiver, and statement of parental consent form for a student to participate in a Leadership Development Program. It outlines 7 conditions the student must agree to, including taking responsibility for their safety, following rules to prevent injury, ensuring they are physically able to participate, and obtaining parental consent. The student and parent must both sign to confirm their agreement to the conditions and for the student to participate in the event.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    43 views1 page

    Student Undertaking, Waiver and Statement of Parental Consent

    Uploaded by

    Green
    This document is a student undertaking, waiver, and statement of parental consent form for a student to participate in a Leadership Development Program. It outlines 7 conditions the student must agree to, including taking responsibility for their safety, following rules to prevent injury, ensuring they are physically able to participate, and obtaining parental consent. The student and parent must both sign to confirm their agreement to the conditions and for the student to participate in the event.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    STUDENT UNDERTAKING, WAIVER AND STATEMENT OF

    PARENTAL CONSENT
    NAME:

    SCHOOL:

    ADDRESS:

    NAME AND PHONE NUMBER OF PERSON TO BE CONTACTED IN CASE OF EMERGENCY:

    CONTACT NO. OF DELEGATE:

    I, (whose name appears above), hereby express my intention and willingness to join
    the Leadership Development Program (LDP) as a part of the celebration of National
    Architecture Week 2018 to be held on day three December 07, 2018, Friday, at Vicinity of
    Provincial Capitol, Lingayen Pangasinan. Prior with this activity, I hereby warrant and represent
    that:

    1. I take it as my responsibility to take the necessary precaution or care of avoiding or getting


    involved in any incident that would cause slight, serious or mortal injury upon my person or results
    in the loss or damage to my property and that of another person.
    2. I also understand that I am not to engage in any behavior that could or may lead to any incident
    or could result to loss or damage to property, injury to myself or other person(s).
    3. I understand that it is my responsibility to fully ascertain, if necessary with the help of a medical
    professional, my physical and mental fitness to join this activity.
    4. I understand that I must be sufficiently healthy or free from any medical condition that maybe
    exacerbated or aggravated by my participation in such an activity. Should I be suffering from any
    medical condition that maybe aggravated or exacerbated by such an activity, I commit to
    immediately report such condition in writing to the assigned faculty adviser and excuse myself
    from such an activity.
    5. I have properly informed my parents or the person(s) exercising parental authority over my
    person concerning the nature of the activity which I am joining and likewise secured their advice
    on the measures which I am to undertake for my personal safety and security. Furthermore, I
    have secured their consent for me to join such an activity as evidenced by the signature
    appearing herein.
    6. I am fully convinced that the organization of this particular activity have exercised sufficient
    diligence and care in the preparation and implementation of this activity.
    7. I fully agree to waive any responsibility on the organization, to the school, and the supervisor/staff–
    in–charge in case of any untoward incident that may happen to me in the duration of the event.

    NAME AND SIGNATURE OF PARENT OR GUARDIAN:

    NAME AND SIGNATURE OF DELEGATE:

    ATTENTION:
    FOR THE PARENT OR PERSON EXERCISING PARENTAL AUTHORITY OVER THE
    STUDENT CONCERNED, AFFIXING YOUR SIGNATURE HEREIN SHALL MEAN THAT YOU
    CONFORM TO THE CONDITIONS STATED ABOVE AND CONSENT TO THE PARTICIPATION
    OF YOUR SON/DAUGHTER/WARD IN THE SAID ACTIVITY

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