WAIVER FORM FOR STUDENTS DURING ON/OFF CAMPUS ACTIVITY

Date:
Dear Sir/Madam:
As parent/guardian of ________________________________________________ of
Gr. ______ - St. _______________________, I allow my son/daughter to join and participate in:
[Staff-in- charge will fill-in the needed information]
Department/Unit / Sponsoring Activity: Grade School/Junior High School

Nature of Activity: Robotics Training

Place of Activity: Holy Child Catholic School, Inc.

Date and Time of Activity: Friday 10:00 AM - 12:00 NN

Staff-in- charge: Mr. Rojeviel B. Baloloy / Ms. Maria Alvah Joy Cada

Pick up point: Holy Child Catholic School (Gate 2)

Drop off point: Holy Child Catholic School (Gate 2)

Together with my child, I know that the School and its officers, faculty and staff are expected to exercise the legal
diligence required for the safety and well-being of my child for the duration and the place, date and time of the activity as
stated.

This legal diligence would include oral or written instructions, whether given before or during the activity, that if followed,
would ensure the safety of my child. For that reason, I had meticulously reminded my child to follow all these school
instructions for his/her safety during the entire on/off-campus activity.

If my child disregards or fails to follow those instructions or should act on his/her own, I, together with my child, shall
have no claim against the School, its officers, administrators, teachers, adviser, staff-in- charge should any damage be
caused, or liability be incurred to property or person.

Very truly yours, Noted by:

Cristina Sibulan
_____________________________________ Mr. Rojeviel B. Baloloy
PRINTED NAME & SIGNATURE OF MODERATOR/ TEACHER-IN-CHARGE
PARENT/GUARDIAN
CONTACT NUMBER/S: ______________

___________________________________ Mr. Jerico Martinez

PRINTED NAME & SIGNATURE OF STUDENT Head, Office of the Student Services and Activities
APPROVED BY:

Ms. Jenny Lyn C. Chua, M. Sci., LPT. (SGD)

HS SCHOOL PRINCIPAL