PRIVACY STATEMENT

The event organizers are collecting information

from you as a parent of the student appear hereinto, for the
purpose of documenting your approval. By providing
information about yourself and signing this consent form, you
give your consent in using your information necessary for the
aforementioned purposes.
UNIVERSITY OF THE EAST
After the conclusion of the event and completion
of all necessary reports, this hardcopy shall be disposed of Caloocan Campus
immediately once electronic version of the information is
saved in secure files and necessary reports have been
generated. If you do not wish to be contacted further, kindly PARENT/GUARDIAN CONSENT FORM
inform the organizers.

I hereby give my permission to TYPE NAME OF THE STUDENT HERE AND CHANGE FONT COLOR TO BLACK
to attend the in-campus activity detailed below:

Purpose : Field Demonstration Practice for Kick-Off Activity

Destination : UE Caloocan Field
Full Amount : N/A
Date : Sept 5, 6, 12, 13, 19, 20 22, and 24, 2022
Time : 2:00-6:00 PM
Mode of Transportation : N/A

Proponent In-charge: Mr. Christian Orbe Cellphone No. ____________________________

Please Check
I received a detailed itinerary of the in-campus activity [ ] YES [ ] NO
I received a list of things the student should/should not bring [ ] YES [ ] NO

As parent/guardian of the above name student, I have fully read the on-campus activity itinerary and I understand
that there are risks and hazards associated with the participation in these activities.

I hereby authorize qualified emergency medical professionals to examine and in the event of serious injury or
illness, administer emergency care to the above named student. I understand every effort will be made to contact me to
explain the nature of the problem prior to any involved treatment.

In the event it becomes necessary for the proponent in-charge to obtain emergency care for the named student,
neither he/she nor the University assumes financial liability for the expenses incurred because of the accident, injury,
illness, and/or unforeseen circumstances.

These activities are extension of the University’s educational program and student’s manner and conduct is to be
in accordance with the University’s rules and regulations.

___________________________________________________ ______________________
PARENT / GUARDIAN (Signature over printed name) DATE SIGNED

________________________ __________________________ ________________________

CELLPHONE NO. HOME PHONE NO. WORK PHONE NO.

I hereby declare that I am physically fit and voluntarily joining the above stated in-campus activity. I release the
University of the East from any liability arising or may be attributed to my participation in this event.

I pledge that my manners and conduct will, at all times, reflect credit upon my University, my parents, and myself.
I understand that the University rules and regulations apply for the entire duration of our in-campus activity. I hereby
voluntarily participate in our in-campus activity.

___________________________________________________ ______________________
PARTICIPATING STUDENT (Signature over printed name) DATE SIGNED

Noted by:
____________________________________________ ______________________
PARENT / GUARDIAN (Signature over printed name) DATE SIGNED