COMMUNITY ENGAGEMENT, SOLIDARITY AND CITIZENSHIP

DEPARTMENT OF EDUCATION
DIVISION OF DINAGAT ISLANDS
R.E. ECLEO SR. NATIONAL HIGH SCHOOL
R. E. ECLEO SR. CAGDIANAO, DINAGAT ISLANDS

STUDENT WAIVER

I, ____________________________ presently enrolled in ________________(STRAND/GRADE) present

myself to participate in Sport-Fist: Return Culture Games as part of our school activity and to hereby pledge
that:

1. I will obey and abide the rules and regulations promulgated, enforced by the school, carried by the
teacher-in-charge for the protection and safety of all;

2. I hereby waive and renounce my rights to all damages, hospitalization and the like. I will not hold the
school, staff and the teacher concerned responsible for any misfortune, injury or accident be slight or serious,
that may happen in connection with the activities or requirements. The cause of which will be attributable to my
acts of disobedience, negligence and the offense advice, warning, precaution and safety rules that were
discussed to me the subject-teacher in charge before the start of the activity.

The content of this waiver was read and explained to me before I affix my name and signature this ____th day
of _______, 2023 freely and voluntarily.

Thank you very much!

Yours truly,

Name of Student Name of Parent/Guardian

(Signature over Printed Name) ( Signature over Printed Name)