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Consent and Waiver

This document is a consent and waiver form for a student participating in an off-campus activity organized by the University of Saint Anthony. Parents or guardians agree to pay any required contributions, acknowledge the risks involved, and assume responsibility for any incidents caused by the student. The form also allows for specific permissions regarding side trips or drop-off locations during the activity.

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Phine Tanay
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40 views1 page

Consent and Waiver

This document is a consent and waiver form for a student participating in an off-campus activity organized by the University of Saint Anthony. Parents or guardians agree to pay any required contributions, acknowledge the risks involved, and assume responsibility for any incidents caused by the student. The form also allows for specific permissions regarding side trips or drop-off locations during the activity.

Uploaded by

Phine Tanay
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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CONSENT AND WAIVER

For Off-Campus Activity


OSAA No.____________

We,____________________________and___________________________/______________________________,
Name of Father Name of Mother Name of Guardian

of legal ages, and residents of _______________________________________________________, are the


Address
_______________________________ of __________________________________, who is currently enrolled
Relation to the Student Name of Student

as ___________________________________________ of University of Saint Anthony.


Grade/Year/Section/Course

I. I/We hereby freely and consciously give my/our consent for


_____________________________________________, to join and participate in the
Name of Student

_____________________________________________ on _____________________________________________
Activity/Event/Trip/Travel Date of Activity/Event/Trip/Travel
as part of his/her curricular/extracurricular activity.
II. I/We agree and, thus, undertake to pay the common contribution of
Php ______________ (if not applicable, put N/A) before my/our child/ward’s departure
from the University.

III. I/We fully and knowingly understand that my/our child/ward will strictly abide by the
policies and guidelines set by the University during the course of the
activity/event/trip/travel.

IV. Likewise, I/we are aware of the usual risks and dangers inherent in the said
activity/event/trip/travel. (For sports events or events with the same nature)

V. I/We fully understand and assume responsibility for any untoward incident towards
third persons caused by my child/ward’s negligence and recklessness. Further, I/we are
conscious that the University, its officials, and accompanying personnel may not be
held responsible for untoward and unforeseen incident that may happen beyond their
control.

VI. For activity such as Trip/Travel, I/We are allowing my child/ward to:
i ( ) to go on side trip
ii ( ) to be dropped off at ___________________________________________________.

Done this ______day of March, 2025 at ________________________________________________________.

______________________________________ ___________________________________________
Father’s Signature Over Printed Name Mother’s Signature Over Printed Name
Contact number/s: _________________ Contact number/s: ____________________

__________________________________________
Guardian’s Signature Over Printed Name
Contact number/s:_______________
Noted:

2/E WENIFREDO R. LACOSTE MRS. DAISY SOTO JUDAVAR


OIC, College of Maritime Education Dean, Student and Alumni Affairs

USANT-F-OSAA-01 Rev.00 July 22, 2024

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