PARENT’S CONSENT

I am allowing my son/daughter ________________________________, with ID number ______

to join and participate in:

Sponsoring Unit : __DWCC__________________________________________

Title of Activity : Limited Face-to-Face Classes & Co-Curricular/Extra Curricular Activities
Date of Activity : AY 2022-2023
Venue and address of the Activity: _Divine Word College of Calapan______________________
Coordinator : __Office of the VPAA; Student Affairs Office__________________

Together with my child, I know that the organization and its officers, faculty, and staff are expected
to exercise the due diligence required for the health, safety, and well-being of my child during the
activity on adhering date. The due diligence includes oral and written instructions, given before
or during the activity, that would ensure the safety of my child.

In addition, I expressly undertake any risks and hazards involved with my child's participation in
the activity, including but not limited to those related to the COVID-19 or similar type virus. I realize
that by participating in the activity, my child may be exposed to faculty, staff, administrators, and
other students and that he or she may get COVID-19, as well as other viruses and diseases.

Further, I hereby authorize and give permission for faculty, staff, school physician, and
administrators to ask general questions related to COVID-19 symptoms and take appropriate
actions in reporting any concerns, if necessary, prior to this activity. That emergency medical
treatment is to be rendered for any injury received while participating in any supervised events.
This authorization includes, but is not limited to, any treatment deemed necessary by certified
personnel, physicians, hospital emergency room physicians, and hospitals.

I certify that my child is in excellent health, does not have a fever, and does not have any current
difficulties that would make it unsafe for him or her to engage in an activity where a medical expert
is not present. If my child has a fever or illness or tests positive for COVID-19, I will notify the
school and not send him/her to the activity.

If my child disregards or fails to follow instructions, including the safety and health protocols, or
should act on his/her own, I, together with my child shall have no claims against the institution,
the organization, faculty, staff-in-charge of any damage or liability to be sustained to any property
or any person.

My signature below indicates that I have been given a copy of the DWCC Health and Safety
Protocol/Guidelines, that I have reviewed, and that I give permission for my child to participate.

IN WITNESS WHEREOF, I have set my hand and signature this _____ day of ________, 2022
at ___________________, Philippines.

SIGNED IN THE PRESENCE OF:

_ MICHELLE B. LUZON____ _BR. HUBERTUS GURU, SVD, Ed.D.___

Student Affairs Office Director Vice President for Academic Affairs

________________________________________
Signature above Printed Name of Parent/Guardian
Contact Number: __________________________
 PARENT’S CONSENT

REPUBLIC OF THE PHILIPPINES)

____________, )s.s.

SUBSCRIBED AND SWORN to before me this _____ day of ______, 2022 at _________,
Affiant having exhibited to me her/his government issued ID issued on ________ at
__________.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2022