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BSE - Student Waiver Form

The document is a waiver form for a student participating in an educational tour to Cebu City from November 5-9, 2024, as part of the SpT ELEC 433 Agri-Tourism Management course. Parents/guardians grant permission and acknowledge understanding of the risks involved, releasing the school from liability. The form includes sections for signatures, student information, and emergency contact details.

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Lenier Sanchez
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26 views2 pages

BSE - Student Waiver Form

The document is a waiver form for a student participating in an educational tour to Cebu City from November 5-9, 2024, as part of the SpT ELEC 433 Agri-Tourism Management course. Parents/guardians grant permission and acknowledge understanding of the risks involved, releasing the school from liability. The form includes sections for signatures, student information, and emergency contact details.

Uploaded by

Lenier Sanchez
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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EASTERN VISAYAS STATE UNIVERSITY

Tacloban City
Control No. EVSU-SASO-F-122
Title of Form: Student Waiver Revision No. 00
Date March 09, 2023

Date: September 25, 2024

Name of Activity SpT ELEC 433 Agri-Tourism Management (with


Experiential Learning Activity)/ Educational Tour
Type of Activity Educational Tour
Place of the Activity Cebu, City
Date/s of Activity November 5-9, 2024

I hereby grant permission to my son/daughter to participate the above mentioned activity.

I fully understand that all the necessary precautions will be taken into consideration to ensure the
safety and wellbeing of my son/daughter for the duration at the said activity. However, I cannot
hold the chaperon/instruction/companion at the school responsible for any on toward incident or
unforeseen event that may happen beyond control I hereby release and discharge the above named
sponsor from all liability arising out of or in connection with the Above-describe activity.

Name of student participant ____________________________________________________

I/WE HEREBY AGREE that the student participant will comply with all of the above statements
listed.

_____________________________________ __________________________________
Signature over Printed name of the Parent/Guardian Signature over Printed name of the Student

Recommending Approval:

ROTCHIE P. CASTIL, PhD SHEENA MAE S. AYO, MM


Entrepreneurship, Program Coordinator Coordinator, Student Affairs & Services Office

Approved:

GERALD JAYSON B. BALANGA, PhD


Campus Administrator
Student Address: _______________________________________________________________
Student Contact Number: ________________

In the event of illness or accident, please notify:


Name: ____________________________ Relationship to Student: ____________________
Address: ______________________________________________________________________
Contact Number: _______________________

ACKNOWLEDGEMENT

Republic of the Philippine)


) SS.

SUBSCRIBE AND before me this _______________________


SWORN day of
____________20___________ at ________________ Philippines.

NOTARY PUBLIC

Doc. No. __________


Page No. __________
Book No. __________
Series of 20________

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