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Waiver

This document is a Parent Approval and Release form that authorizes a student to participate in an off-campus activity under the supervision of university personnel. It includes a medical release clause allowing for medical treatment if necessary, and outlines the parent's responsibility for any medical expenses incurred. Additionally, it requires the parent to list any medications the student takes and provides space for emergency contact information.

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shanly villanueva
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28 views2 pages

Waiver

This document is a Parent Approval and Release form that authorizes a student to participate in an off-campus activity under the supervision of university personnel. It includes a medical release clause allowing for medical treatment if necessary, and outlines the parent's responsibility for any medical expenses incurred. Additionally, it requires the parent to list any medications the student takes and provides space for emergency contact information.

Uploaded by

shanly villanueva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Page 1 of 2

PARENT APPROVAL AND RELEASE


Name of Student: Program & Section:
Activity Date(s): Title of Activity:
I, the undersigned parent / legal guardian of the student whose name is stated above, do hereby authorize him / her to
participate in the said activity. I understand that during this off-campus activity, my son / daughter will be under the direction
and general supervision of the Nationalian Office, and the personnel selected by the University. I am aware that my son
/ daughter might be subjected to disciplinary action for his / her conduct during the stated activity.
MEDICAL RELEASE
In the event that my son / daughter needs medical attention during the activity, I hereby give my permission to the
Nationalian Office Representatives to take my son / daughter to a physician, hospital, or other medical institution for
treatment. I explicitly authorize all medical treatment which a physician may determine necessary under the
circumstances and understand that it may not be feasible to contact me prior to the provision of medical treatment to
my son / daughter. I understand and agree that I as parent / legal guardian is responsible for all the medical expenses
incurred in treating my son / daughter unless it is related injury, and that time the Nationalian Office Representatives for this
off-campus activity are not responsible for such expenses.
In addition, I do authorize the Nationalian Office Representatives to administer or dispense the prescription and / or non-
prescription medication indicated on this form to my son / daughter as appropriate. I also understand that I must complete
this form and provide to University Representatives any medications indicated here that I want to be administered /
dispensed to my son / daughter during the off-campus activity.
List any medications that the student takes while on the off-campus activity, the instruction for administering
each medication, and the medical condition for which the medication is needed.
Medication Instruction Medical Condition
Page 2 of 2

Name of Parent / Legal


Guardian
Contact Number

Health Insurance Company

Policy Number

In case that I cannot be reached, below are the emergency contacts:

Name & Contact Number

Name & Contact Number

Name & Contact Number

Signature Over Printed Name of Parent / Legal Guardian Date Signed

Parent’s / Legal Guardian’s Scanned Copy of Valid ID

Parent’s / Legal Guardian’s Three (3) Specimen Signatures

Note: You may use a separate paper to attach the scanned copy of valid ID with three (3) specimen signatures.

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