PARENTAL CONSENT AND WAIVER FORM
I, (NAME OF PARENT)______________________________________________________, as
the parent or legal guardian of (NAME OF
STUDENT)_____________________________________________________________, hereby
acknowledge that I have been informed of the details of the conduct of the face-
to-face SELG Leadership Training that will be held on February 22, 23, & March 1
at Baguio Central Elementary School.
I understand that the (Name of Office) shall implement the minimum public
health standards set by the government to minimize the risk of the spread of
COVID-19, but it cannot guarantee that my child will not become infected with
COVID-19 given that it is highly contagious.
I understand that my child’s in-person attendance in the event will include
associating with teachers, fellow learners and school personnel, and other
persons inside and outside of the school that may put my child at risk of COVID-
19 transmission, notwithstanding the precautions undertaken by the
implementing team.
Voluntary Participation
I acknowledge that my child’s participation in this activity is completely
voluntary. My child may decline to participate or withdraw from participation at
any time for any reason. Declining or withdrawal of participation will not result in
any penalty or loss of benefits or reduction of any basic right to which my child is
entitled. While there remains the risk of possible COVID-19 transmission to my
child/ren, and to the members of my household, I freely assume the said risk and
I permit my child/ren to attend this activity.
Exclusion (Limitations/Ineligibility)
I am aware that symptoms of COVID-19 include, but are not limited to, fever or
chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body
aches, headache, the new loss of taste or smell, sore throat, congestion or runny
nose, nausea, vomiting, and diarrhea.
I confirm that my child currently has none of those symptoms and is in good
health. I will not allow my child to physically go to the event if my child or any
member of my household develops any of the said symptoms or any other
symptoms of illness that may or may not be related to COVID-19. I will also
inform the school/division and not allow my child to attend the event if my child
or any of my household members tests positive for COVID-19. My child/ren and I,
with my household members, will follow the required health and safety protocols
and procedures adopted by the school and community.
Documentation
I confirm that I give full permission in any recording or picture taken of my child
during the conduct of this event and to use some or all of my child’s images/
contribution/ performance in any publication (including electronic publications
such as film or website) created by or for the District Office and to release this
material to Baguio District official platforms.
Confidentiality
I am aware that any information that will be given during the activity will be kept
strictly confidential, and personal information will be treated in accordance with
the Data Privacy Act of 2012. I am assured that the information about my child
will not be shared outside of the implementation team. My child’s name will not
be used when data from this activity is analyzed.
I hereby confirm that I agree and understand the commitment of my child as a
participant. I also understand and will support my child’s endeavor to meet the
expectations, guidelines, and responsibilities to his/her fellow participants and to
the Baguio District SELG Training.
To the extent allowed by law and rules, I hereby agree to waive, release, and
discharge all claims, causes of action, damages, and rights against the
school/division and its personnel as well as officials and personnel of the School:
Mangas-as I.S. relative to the conduct of the activity.
With full understanding, I – on behalf of myself, my household members, and my
child/ren – hereby freely and voluntarily give my consent to my child’s
participation in the activity from February 22, 23, & March 1. I also attest that I
had sought the views of my child and he/she has expressed a willingness to
participate in the activity.
CONTACT DETAILS FOR QUESTIONS OR PROBLEMS
For any concerns or clarification, you may contact the Office of the Assistant
Secretary for Operations through the Bureau of Learner Support Services-Youth
Formation Division through the email address
[email protected] (cc:
[email protected]) or through telephone number +632 8 637 9814.
_____________________________ _____________________________
Signature of Parent/Guardian over Contact Details (Mobile Number)
Printed Name
_____________________________ _____________________________
Name of Child/ren Date
* Please submit this form to your child’s school prior to participation in the event.
