CONSENT FORM

I, __________________________________________, a student enrolled in _______________________________________ at

(Full Name) (Course, Year and Section)
Dalubhasaang Politekniko ng Lungsod ng Baliwag understands that National Service Training
Program includes community-based activities, plans and preparations for project proposal, inquiry
with the target community, documentary requirements and other logistics prior to the actual
community service.

I will fully participate in all activities to partake in such performances and I give my express consent
for the BTECH staff, its employees and __________________________________, teacher/ facilitator of the
(Teacher’s Name)
subject unaccountable in any mishap/accident occur during the conduct of such activities.

By my signature on this document, I agree to the terms written above.

____________________________________________________
STUDENT SIGNATURE OVER PRINTED NAME

_______________
Date

WAIVER

I, _______________________________________, the parent/guardian of ________________________________________,

(Parent’s name) (Student’s name)
completely allow him/her to full participate in community-based activities of National Service
Training Program (NSTP).

I understand that BTECH management will do all possible precautions to provide for the safety of my
child. In the event of an accident in which my child is injured, I agree to render the BTECH, its
employees, and the teacher/facilitator of the subject, unaccountable in any mishap/accident occur
during the conduct of such activities.

By my signature on this document, I agree to the terms written above.

_____________________________________________________
PARENT’S SIGNATURE OVER PRINTED NAME

_______________
Date