WAIVER AND PARENTAL CONSENT

My minor child, _________________________, (“the Minor”) has been selected as a tutee in the
(Project Title). It is coordinated by (Name of Student), an NSTP student of SLSU-JGE Tagkawayan. The
Minor has my consent to be a tutee. I understand the nature and requirements of the Program. With
that understanding, it is my judgment that the Minor is able to participate in the Program. I
acknowledge that the Minor’s participation in the Program is voluntary.

Due to the age of the Minor, the program requires that this Agreement be executed by me in
consideration of the Minor’s being permitted to participate in the Program. I agree to and
acknowledge the following:

(1) I am the Minor’s parent or legal guardian.

(2) I agree that the tutor can visit the Minor in our premises and let him guide the Minor during the
tutoring hours.

(3) I agree that the Minor may be photographed, audio or videotaped by the tutor. I agree that
photographic image(s) and information that correspond with the photographic image(s) may be
disseminated for any public usage by tutor.

(4) As parent of the Minor, I understand that there are safety risks associated with the Minor’s
participation in the said program.

____________________________________________
_________________________

Parent/Guardian Signature Date

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Printed Name
 PARENTAL CONSENT, ASSUMPTION OF RISK AND WAIVER OF LIABILITY, AND AGREEMENT TO ABIDE
BY COVID-19 PROTOCOLS

My child, _________________________, will be conducting the (Project Title) activity. Due to the
current situation, the program requires that this Agreement be executed by me in consideration of
the student’s being permitted to conduct this program. I agree to and acknowledge the following:

(1) I am the parent and/or legal guardian of the above-named student, and I give him my permission
to conduct the said program/activity.

(2) Assumption of Risk. I understand and acknowledge the risk to my child, of becoming exposed to or
infected by COVID-19 in conducting the program. I assume all such risk and accept sole responsibility
for any harm or loss to my child, including, but not limited to, personal injury or death or related costs
or expenses of any kind, that my child may experience or incur in connection with the said
program/activity.

(3) Waiver of Liability. In consideration for this school-related activity, I, on behalf of my child hereby
release and hold harmless the School, and their employees, volunteers, and/or representatives
thereof, from any and all liability for any and all harm or losses arising from participation in the
school-related activity, including, but not limited to, exposure to or infection by COVID-19, which
exposure or infection may result from the actions, omissions, negligence or other conduct of the
School, and their officials, employees, volunteers or representatives. Further, I covenant (i.e. promise)
not to sue the School or any official, employee, volunteer, and/or representative thereof, for any such
harm or loss.

(4) Agreement to Abide by COVID-19 Protocols. I agree that my child must abide by the COVID-19
protocols in doing the said program/activity.

I certify that I have read and understand the contents of this Parental Consent, Assumption of Risk
and Waiver of Liability, and Agreement to Abide by COVID-19 Protocols, and that it is my intention by
my signature that it bind not only on me, but my heirs, administrators, executors, successors, and
assigns, and, my child.

____________________________________________
_________________________

Parent/Guardian Signature Date

____________________________________________

Printed Name