Consent Don Pepot

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Division School Sports, Events & Activities Unit

Parental Consent

I________________________________ the undersigned as the parent/legal guardian of the child


named below, do hereby give my full consent and approval for my child to participate in CITY MEET 2023.

I hereby certify that my child is fully capable of participating in CHESS COMPETITION and that my
child is healthy and has no physical/mental disabilities or infirmities that would restrict full participation in this
activity for the school year 2022-2023.

In addition to giving my full consent for my child’s participation, I do hereby waive, release and hold
harmless the organization/school, its officers, coaches, sponsors, supervisors, and representatives for any
injury that may be suffered by my child in the normal course of participation in the designated sport and the
activities incidental thereto, whether the result of negligence or any other cause.

Name of parent/legal guardian:____________________________Signature:________________________


Mother: ___________________________________Signature:___________________________________
Father: ___________________________________ Signature:___________________________________
Complete Address: _____________________________________________________________________
_____________________________________________________________________
Contact Number of parent/ guardian:________________________________________________________

Name of child: ___________________________ Date of Birth:___________________________________


Grade & Section: _________________________Contact Number:________________________________

Signed Over Printed Name:

__________________________ _____________________________
Class Adviser Coach

___________________________ _____________________________
Sports Coordinator MAPEH Coordinator

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