Republic Colleges of Guinobatan, Inc. G. Alban St.

Iraya,
Guinobatan, Albay Phil

Parent’s/Guardians Permit Form

PLEASE TAKE NOTE CAREFULLY SY 2017-2018
1. Please fill up this form in BLOCK LETTERS.
2. ALL sections MUST BE COMPLETED when applicable.

TO WHOM IT MAY CONCERN:

We/I, _____________________________ of legal age, residing at ______________________________

Name of Parent/Guardian Address
With contact no. ______________________. Being the parent/guardian of _____________________________,
Cellphone No. Name of Student
______________________, in Republic colleges of Guinobatan, Inc., hereby expressly declare that I am
Year & Section
voluntarily permitting my above-mentioned son/daughter to attend the SCI-MATH CAMP 2017 with the theme
“Promoting Science and Mathematics for Technology and Educational Advancement” on October 26-28, 2017
at Republic colleges of Guinobatan, Inc.

We/I understand that our son/daughter/ward:

1. Is in good condition and will actively and fruitfully participate in all camp activities especially during plenary
sessions.
2. Will be subjected to the rules and regulations of the camp. If he/she violates any rule, he/she will be dismissed
from the camp and we/I will fetch him/her.
3. Will segregate his/her wastes and throw the trash properly to maintain the cleanliness of the camp area and
classrooms.
Further, I hereby waive any claim against Republic Colleges and its members, officers, teachers and
employees for injury, damage, liability and/or loses that the above-mentioned student may incur for a cause not
directly and immediately resulting from error, fault or gross negligence on the part of Republic Colleges of Guinobatan,
Inc. and/or its members, officers, teachers and employees.
NOTE: IF THE STUDENT IS A MINOR, BOTH PARENTS MUST SIGN THE PERMISSION FORM.

I/We have honestly and accurately completed all parts of the Parents’/Guardian’s Permit Form to the best of
my/our ability.
__________________________________________ _________________ ____________________________________________ ________________
Parent/Guardian Signature #1 Date Parent/Guardian Signature #2 Date

_______________________________________________________________ _____________________________________________________________
Parent/Guardian Name (please print) Parent/Guardian Name (please print)

_______________________________________________________________ _____________________________________________________________
Complete Addreaa Complete Address
_______________________________________________________________ _____________________________________________________________
Contact Number/s Contact Number/s

CAMPER’S CONTRACT
I, __________________________________ of Republic Colleges of Guinobatan, Inc., High School Dept.
Voluntarily join the 2017 SCI-MATH CAMP on October 26-28, 2017 at Republic Colleges of Guinobatan, Inc.

1. I will follow wilfully all the rules and regulations of the camp. If I violate any of the rules, I will be dismissed
from the camp.
2. I will be responsible for all my action and decisions in the entire duration of the camp.
3. I will actively and fruitfully participate in the activities especially during plenary sessions without reservations.
4. I will segregate my waste and throw my trash properly to maintain the cleanliness of the camp area and the
classroom.

I hereby voluntarily waive any claim against the organizers for any untoward incident that may happen beyond
their control in the course of his/her participation after all precautionary measures and reasonable care ad effort that
have been taken by the organizers.

Signed this________ day of October 2017.

__________________________________ ____________________________________
Signature over printed name Signature over printed name
STUDENT ADVISER

SCI –MATH CAMP 2017

HIGH SCHOOL DEPARTMENT-Sci-Math Club