GOLDEN WEST COLLEGES

PARENT AND STUDENT WAIVER FORM

I am allowing my son/daughter, ________________________________, with ID number ____________,

from the College of _______________________, to join and participate in:

Sponsoring Unit : GWC-Senior High School Department

Title of Activity : Regional Press Conference 2016
Nature of Activity : Competition
Date of Activity : December 15, 16, & 17
Time of Activity : 7AM – 5PM
Venue and Address of Activity : La Union
GWC Staff-in-charge : Ms. Irish Jial Ginez & Ms. Rejoice Vida Raguin
Amount to be paid : NONE
Deadline of payment : N/A Date Remitted: N/A

Person to contact in case of emergency

Name of Parent / Guardian : ________________________________________________
Address & Contact Number : ________________________________________________

As the parent / guardian, I know that the college and its officers, faculty, and staff are expected
to exercise the legal diligence required for the safety and well-being of my child for the duration
and the place, date, and time of the activity as stated. This legal diligence would include oral or
written instructions, whether given before or during the activity, that if followed, would ensure the
safety of my child. After the said activity my son/ daughter shall take full responsibility of
him/herself.

If my child disregards or fails to follow those instructions or should act on his/her own, I, together
with my child, shall have no claims against the college, its officers, faculty, staff-in-charge should
any damage be caused or liability be incurred to property or person.

I also agree to abide by the rules and guidelines and pay the necessary fee/s that is/are due
and I give my consent for him/her to pay the said amount.

I further agree that in case my child has a recurring sickness, she/he will seek a medical
certificate signifying that he/she is physically fit to attend activity and that in case her/his
sickness will recur during or after said activity, I will not hold the institution or the staff liable to this
incident given all due diligence during the activity.

________________________________
Signature & Date above printed name of
Parent/ guardian

________________________________
Signature & Date above printed name of
Of Student

IRISH JIAL GINEZ

Signature & Date above printed name of
Of Faculty / Staff-in-charge

BELINDA C. MARTINEZ
Signature & Date above printed name of
OSAD Officer