UNIVERSITY OF SCIENCE AND TECHNOLOGY OF SOUTHERN PHILIPPINES

College of Technology
Electrical and Technology Management Department
Claro M. Recto Avenue, Lapasan
9000 Cagayan de Oro City, Philippines

PARENTAL CONSENT AND WAIVER FORM

I, __________________________, grant permission for my son/daughter, _______________________, to

participate in the Computer Engineering Batch 2011 Educational Field Trip entitled: “Leading and Learning the
way to Outreach One’s Potential through Electrical and Technology” which requires transportation to a
location away from the university site. This activity will take place under the guidance and direction of
the Faculty and Officers of the Electrical and Technology Department, College of Technology of the University
of Science and Technology of Southern Philippines.

A brief description of the tour follows:

Location of the Event: Makati City and Mandaluyong City, Philippines

Date and estimated time of arrival/departure:
Arrival: September 21, 2018. 11:00am
Return: September 23, 2018. 5:00pm
Mode of Transportation: Cebu Pacific Air (Cebu Pacific Philippines, Inc.)
Bus Line Company Service (Victory Liner, Inc.)
Board and Lodging: Prince Plaza II Condotel

I, as parent and/or legal guardian, remain legally responsible for any personal actions taken by the above
named participant.

I agree on behalf of myself, my child named herein, or our heirs, successors and assigns, to hold harmless and
defend University of Science and Technology of Southern Philippines, its officers, directors and agents,
employees, faculty, or representatives associated with the event, from any and all actions, claims, demands,
damages, costs, expenses and all consequential, damage arising from or in connection with my child
attending the event or in connection with any illness or injury cost of medical treatment in connection
therewith.

In signing the Parental Consent and Waiver, I am not relying on any oral or written representation or
statements made by the university and , its officers, directors and agents, employees, faculty, or
representatives associated with the event, to induce me to permit my student to take the trip, other than
those set out in this Consent and Waiver.

I am 18 years of age or more and have read and understand the terms of this consent and waiver, and
recognize that it is binding upon me, my heirs, executors and administrators.

Parent/Guardian over Printed Name Date