PARENTAL CONSENT AGREEMENT/AFFIDAVIT OF CONSENT

Permission is granted for my son/daughter to participate in 2020 PICE Regional

Convention at Notre Dame of Dadiangas University (NDDU) Campus, Marist Ave.,
General Santos City on February 16-18, 2020
Name of Participant LOVER VONN M. PALMES
Date (s) of the Activity or February 16-18, 2020
Event
Venue of the Activity or Event NDDU Campus, Marist Ave., General Santos City
Activity 2020 PICE Regional Convention

We hereby acknowledge that sufficient information has been provided by the

PHILIPPINE INSTITUTE OF CIVIL ENGINEERS SKSU STUDEN CHAPTER with
respect to the planned activity, duration, location, participants and supervision.

We hereby acknowledge that certain risks are inherent to participate in learning

activities outside the school. These types of injuries may be minor or serious and may
result from one’s action, or the actions or inaction of others, or a combination of both.

We read the rules and regulations established for the camp and agree that they
designed for the safety and protection of the trainees and hereby undertake to inform
my child to abide by these rules and regulations.

We understand that:

1. A minimum level of fitness and health (physical, mental and emotional) is

required.
2. Each person has a different capacity for participation, and;
3. Any exceptions to full participation are identified in the medical certificate.

We declare having read and understood the above Parental Consent Agreement in its
entirety and hereby consent to allow my/our child to participate, acknowledging all of the
foregoing.

JOCELYN M. PALMES January 22, 2020

Parent/Guardian Signature over Printed Name Date

LOVER VONN M. PALMES January 22, 2020

Delegate Signature over Printed Name Date