Senior High School Department

September 10, 2018

Dear Mr./ Mrs. _______________________

We would like to inform you that your child/ ward ___________________________, as a senior high school
student will participate on the HUMSS LIKHAAN AT PAUTAKAN on September 11, 2018 from 8:00am - 12:00nn inside
the School Campus.

Should you have any queries about the activity, please feel free to contact the teacher in charge of the activity.
Thank you and God Bless.
Ms. Anna Mariztela C. Santos 09558947990
HUMSS Synergy Moderator
-----------------------------------------------------------------------
WAIVER FORM
I wish to inform the University of Perpetual Help System DALTA – Molino Campus that I am voluntarily allowing
my child / ward to join the:
Activity: HUMSS LIKHAAN AT PAUTAKAN
Date: September 11, 2018 (8-12) Pocket Money : As Desired
Venue: UPHSD Transportation : On their own
With clear and mutual understanding the precaution will be taken by the concerned moderators/ trainer or
teachers – chaperon to ensure his / her safety during practices and rigid training I shall not hold anyone of them not the
school or its officials responsible for any untoward incident that may happen beyond control.
____________________________ ______________________________
Name of student/ Year and Section Parents’ Signature over Printed Name
_______________________________________
Address and Contact number of Parents

UPHMO-SHS-ADM-435/rev0 Waiver Form/ Page 1 of 1 Page

Senior High School Department

UPHMO-SHS-ADM-435/rev0 Waiver Form/ Page 1 of 1 Page

September 10, 2018

Dear Mr./ Mrs. _______________________

We would like to inform you that your child/ ward ___________________________, as a senior high school
student will participate on the HUMSS LIKHAAN AT PAUTAKAN on September 11, 2018 from 8:00am - 12:00nn inside
the School Campus.

Should you have any queries about the activity, please feel free to contact the teacher in charge of the activity.
Thank you and God Bless.
Ms. Anna Mariztela C. Santos 09558947990
HUMSS Synergy Moderator
-----------------------------------------------------------------------
WAIVER FORM
I wish to inform the University of Perpetual Help System DALTA – Molino Campus that I am voluntarily allowing
my child / ward to join the:
Activity: HUMSS LIKHAAN AT PAUTAKAN
Date: September 11, 2018 (8-12) Pocket Money : As Desired
Venue: UPHSD Transportation : On their own
With clear and mutual understanding the precaution will be taken by the concerned moderators/ trainer or
teachers – chaperon to ensure his / her safety during practices and rigid training I shall not hold anyone of them not the
school or its officials responsible for any untoward incident that may happen beyond control.
____________________________ ______________________________
Name of student/ Year and Section Parents’ Signature over Printed Name
_______________________________________
Address and Contact number of Parents