PHILIPPINE INSTITUTE OF CIVIL ENGINEERS, INC.

ACADEMIA DE TECHNOLOGIA IN MINDANAO, INC.

4A DON ROMAN VILO ST., COTABATO CITY, PHILIPPINES
Landline: (064-4310550) Mobile No.: (0917-1536-742)
Email Add.: adtmindanao@gmail.com
__________________________________________________________________________________________

PARENTAL CONSENT AND WAIVER

I, ________________________________________________, _________ years old and residing at

________________________________________ currently enrolled in Academia De Tecnologia in
Mindanao Inc. and will be participating in the PICE Regional Student Summit 2024 that to be held at
Kidapawan City this coming February 15-17, 2024. In consideration thereof, do hereby freely accept
the following:
1. That I am currently studying Bachelor of Science in Civil Engineering and as part of ADTM-PICE
Student Chapter Organization, I am voluntarily participating in the upcoming PICE Regional Student
Summit as a representative of our school, Academia De Tecnologia in Mindanao Inc.
2. That I recognize the authority of the organizers, facilitators and officers, and submit myself to all the
reasonable rules and regulations that are imposed upon me in connection with the above-said event.
3. That I hereby waive that the organizer, facilitators and officers, and the Academia De Tecnologia in
Mindanao Inc. is free from any liabilities arising from any untoward incident during the period of the
said event.

Signed in the _________________, Philippines, this ___ day of ______, 2023.

__________________________________
Student’s Signature over Printed Name

WITNESS:

With the consent and approval of the Parent/ Guardian:

___________________________________________
Signature over Printed Name of the Parent/ Guardian

Any Valid I.D. No. ______________

Address: ___________________________________________________________
 PHILIPPINE INSTITUTE OF CIVIL ENGINEERS, INC.
ACADEMIA DE TECHNOLOGIA IN MINDANAO, INC.
4A DON ROMAN VILO ST., COTABATO CITY, PHILIPPINES
Landline: (064-4310550) Mobile No.: (0917-1536-742)
Email Add.: adtmindanao@gmail.com
__________________________________________________________________________________________

CAR SERVICE WAIVER

I, _____________________________________________, of legal age, Filipino, and a resident of

__________________________________ and is currently enrolled in Academia De Tecnologia in
Mindanao Inc., hereby acknowledge and agree to the terms and conditions outlined in this waiver in
consideration for being permitted to use my personal vehicle as a service for the upcoming PICE
Regional Summit on February 15-17, 2024 to be held in Kidapawan City. After having been duly sworn
to in accordance with the law, do hereby depose and says;
1. Vehicle Information: My vehicle is registered, insured, and in good condition.
2. Responsibility: I am solely responsible for my vehicle's maintenance and safety during the
Summit.
3. Liability: The ADTM (Academia De Tecnologia in Mindanao Inc.) School Officials are not
liable for any accidents or damages during the event.
4. Insurance: My vehicle is covered by a valid insurance policy.
5. Indemnification: I promise to cover any costs or issues that may come up because of how I use
my vehicle.
6. Safety: I will follow safety guidelines provided for the use of personal vehicles during the
Summit.
I acknowledge the risks and agree to these terms voluntarily.

IN WITNESS WHERE OF, I have here unto set my hand this ____day of ______________ 2024 at
____________________________, Philippines.

______________________ ______________________ MS. MELODINA D. TORRES

Affiant Parents/Guardian Dean, ADTM

(Republic of the Philippines, City of Cotabato) S.S

SUBSCRIBE AND SWORN TO before me this ____day of ________________ 2024 at
______________________________________, affiant appears me exhibiting to me his/her Community
Tax Certificate No. __________________ issued at ____________________________, Philippines.
Affixed my signature and seal this day above-written.

Doc. No. _______________

Page No. _______________
Book No. ______________
Series No. ______________ NOTARY PUBLIC