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  • Waiver and Consent

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    Bianca Ceniza Evarita
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    The document contains two consent forms for a CTUC program at Negros Oriental State University - Bais Campus I College of Criminal Justice Education. The first form is for a student participant to consent to any risks of participation. The second form collects medical information about a child participant and has the parent/guardian consent to the child's participation and transportation. Both forms require the printed name, signature, and date to be filled in.

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    The document contains two consent forms for a CTUC program at Negros Oriental State University - Bais Campus I College of Criminal Justice Education. The first form is for a student participant to consent to any risks of participation. The second form collects medical information about a child participant and has the parent/guardian consent to the child's participation and transportation. Both forms require the printed name, signature, and date to be filled in.

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    © All Rights Reserved
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    7 views2 pages

    Waiver and Consent

    Uploaded by

    Bianca Ceniza Evarita
    The document contains two consent forms for a CTUC program at Negros Oriental State University - Bais Campus I College of Criminal Justice Education. The first form is for a student participant to consent to any risks of participation. The second form collects medical information about a child participant and has the parent/guardian consent to the child's participation and transportation. Both forms require the printed name, signature, and date to be filled in.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 2

    Negros Oriental State University

    Bais Campus I
    College of Criminal Justice Education

    I, _______________________________, a BSCRIM student in NORSU-BAIS,


    VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS,
    PROPERTY DAMAGE, OR PERSONAL INJURY, THAT MAY BE SUSTAINED BY ME AS
    A RESULT OF PARTICIPATION IN THIS CTUC PROGRAM. I hereby affirm that I am in
    good physical condition and do not suffer from any known disability or condition
    which would prevent or otherwise limit my full participation in this physical program.

    _________________________ Date: March __, 2023


    Printed Name and Signature

    _________________________________________________________________________

    Negros Oriental State University


    Bais Campus I
    College of Criminal Justice Education

    Name of Child:
    Date of Birth:
    Address:
    Phone Number:
    Does your child suffer from any medical conditions/allergies that the program should
    be aware of (including any current medication) ? (Yes, No) (If yes, indicate below)

    Please provide details of medication that must be administered:

    Emergency contact details: (If different from above)


    Name:
    Relationship to child:

    CONSENT (please read carefully)


    a) I agree with my son/ daughter taking part in the physical activities of the CTUC
    program.
    b) I confirm to the best of my knowledge that my son/ daughter does not suffer from any
    medical condition other than those listed above. (If any)
    c) I consent to my son/ daughter travelling by any form of public transport, minibus or
    motor vehicle organised by the University/College to any event in which the CTUC
    program/activity is participating.

    _______________________________ Date: March __, 2023


    Printed Name and Signature of Parent/Guardian

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