De La Salle Lipa

Integrated School

PARENT/ GUARDIAN'S
CONSENT

I, Pateña, Alexandra Mae, Filipino, of legal age, and with address at Ibaan, Batangas,
do hereby depose and state that:

1.I am giving permission for my child Allan Alexis Pateña

to participate in the _DLSL 61st Foundation Week Celebration with a theme: “Ika-
Animnapu at Isa Na: Kalayo Na’y May Ilalayo Pa.” _ to be held on February 6-9, 2024 in
DLSL grounds

2.I and my child understand the program and the conditions for which it is being
offered;

3. I and my child are aware of the hazards associated with my child’s participation in
the
activity;

4. I and my child understand that this is a school – sponsored activity and

that my child should conduct himself/herself as a responsible individual;

5. I and my child acknowledge that the rules and regulations of DE LA

SALLE LIPA will apply at all times for the duration of the activity; and,

6. I agree to waive any and all liabilities against the teacher-in-charge and DE
LA SALLE LIPA in case any untoward incident or unfortunate circumstance which,
despite the exercise of due diligence on their part, may occur.

NB In the interest of promoting health and safety for everyone and in view of the ongoing
pandemic, I understand that DLSL will not / does not require me/us to have this Waiver duly
notarized. Nonetheless I / we are fully aware of the binding effects of this 'Parent /
Guardian's Consent Form' between myself / us and DLSL. I / we knowingly and willingly
affix my/our signatures below and I / we undertake to abide fully by its provisions.

Alexandra Mae A. Pateña

SIGNATURE OVER PRINTED NAME
OF PARENT/GUARDIAN

Allan Alexis A. Pateña

SIGNATURE OVER PRINTED NAME OF
STUDENT