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Rotc Parents Waiver and Consent Form 2 1

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HEADQUARTERS

JOSE RIZAL MEMORIAL STATE UNIVERSITY- DIPOLOG CAMPUS


RESERVE OFFICER TRAINING CORPS UNIT
902ND CDC (ZDN), 9RCDG, RESCOM PA
Turno, Dipolog City

PARENT CONSENT AND WAIVER

I/We, ___, parent(s)/guardian of


(Names of Parents/Guardians)
_________________________________, ______________, hereby give our consent to our son/
(Student Name) (Course/Year)

daughter to participate/get involved in the ____ ____________


(Name of Activity)
in______________________________________________ on
(Place of Activity) (Date of Activity)
initiated by _________________________________________.
(Name of Association/Organization)

Further, we give our consent after having understood and concurred to the following
provisions:

(1) We are fully aware that the participation of our son/daughter is voluntary. It is part of
academic requirement this _______semester, SY __________.

(2) As parents/guardian, I/we have talked to my/our son/daughter about the safety and
security concerns regarding the conduct of the abovementioned activity.

(3) I/We have advised my/our son/daughter to follow all the rules and regulations before,
during and after the activity.

(4) In case my/our son/daughter violates the rules and regulations imposed in the entire
duration of the activity, I/we am/are relieving the organizers and the school authorities from any
liabilities after all precautionary measures and exhaustive efforts have been undertaken by the
people in-charge of the activity.

(5) I/We hereby declare and inform the organizers of the special medical needs of my/our
son/daughter: _____________________; ______________________; _________________, etc.

Wherefore, we affix our signature below to certify the aptness and veracity of our consent.

Signed this ___________ day of _____________, 20__.

___________________________ _________________________
Mother/Guardian Father/Guardian
(Signature over Printed Name) (Signature over Printed Name)

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