Professional Documents
Culture Documents
Mental Health Waiver and Commitment, and Consent Form Edited
Mental Health Waiver and Commitment, and Consent Form Edited
_________________________________
Student’s Name & Signature
***
CONSENT
I/We_____________________________________parent(s)/guardian(s) of ________________________________________________
(Name of Parent(s)/Guardian) (Name of Student)
do hereby grant permission and acknowledge by signature that my son/daughter of
_____________________________________ will be continuing his/her studies this school year 2023-2024 with
his/her current mental state as acknowledged by his/her psychiatrist/psychologist _________________________
that he/she is able to meet the demands of the school. A psychological Evaluation report was given to the
school last _________________________________________________________ that includes recommendations and
guidance for teachers and staff, parents, and guardians of our child.
I/We acknowledge being informed about the typical risks and hazards associated with my/our child's
presence within and outside the ADZU Junior High School campus. Consequently, I/we willingly assume
responsibility for any potential adverse events, agree to abide by the school's rules and regulations, and
adhere to the student handbook, recognizing the significance of my/our child's education and personal
development in this supportive environment.
I/We have thoroughly read and comprehended the conditions stated in this consent and waiver.
_________________________________
Parent’s Name & Signature
Witnessed:
__________________________________________ ____________________________________________
Guidance Counselor’s Name & Signature Physician’s Name & Signature
__________________________________________ _________________________________________
Prefect of Discipline’s Name & Signature Home and School Relation Officer’s
Name & Signature
___________________________________________ __________________________________________
Assistant Principal for Formation Assistant Principal for Academics
______________________________
ADZU JHS Principal and
VP for Basic Education
Notary Public