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KLD-01-05-F005
Institute of Student Affairs, Character Education and Citizenship
OFF-CAMPUS ACTIVITY CONSENT FORM
STUDENT INFO
STUDENT NAME (Surname, F.N, M.I) KLD ID NO. KLD-
Residential Address
Institute Program
ACTIVITY
Title of Activity 4th FWC Mr. and Ms. KLD x Acquaintance Party
☐ Curricular (Academic) ☐ Free of Charge
Type of Activity
☐ Non-Curricular (Non-Academic) ☐ With Fee: __________
Venue/s: Dasmariñas Arena Date: Oct. 21, 2024 Time: 1:00 PM - 10:00 PM
Schedule of Assembly Date and Time: Assembly Place:
Activity Departure Time: Arrival Time at the Venue:
Departure Date and Time from Venue:
Mode of transportation ☐ KLD vehicle Third-Party: Personal:
☐Franchisee ☐Travel and tours Operator ☐Own ☐Carpooling ☐ Public
IN-CHARGE
Department/Office/Unit
Faculty/Staff-in-Charge Contact number:
(Signature over printed Email Address:
name) (@kld.edu.ph)
1. I consent to my child/spouse participating in the off-campus activity described above. I understand that this
participation is voluntary and contributes to their academic and overall development.
2. I acknowledge that the school and its officials will provide both oral and written instructions before and during the
activity to ensure the safety and well-being of my child/spouse throughout the duration and location of the activity.
3. If my child/spouse fails to comply with these instructions, the school's rules and regulations, or the venue's regulations,
I undertake this waiver to absolve the school, its officers, or administrators from liability for any negligence or culpable
act by my child or any third party.
4. I understand that my child/spouse will be required to submit a narrative report of their participation in this event to the
Institute of Student Affairs, Character Education and Citizenship for monitoring and documentation purposes.
5. I request that my child/spouse be allowed to disembark at _______________________ after the activity. I accept responsibility
for their whereabouts after the activity concludes.
6. I confirm that my child/spouse is physically and mentally capable of participating in the activity.
7. I/we voluntarily sign this consent, fully understanding our legal rights.
_______________________________________ ______________________________________
Parent/Guardian’s Signature Over Printed Name Student’s Signature Over Printed Name
Mobile Number: _________________________ Mobile Number: _________________________
Email Address: __________________________ Email Address: __________________________
Important:
• Please attach a photocopy of the parent/guardian/next of kin’s valid ID with three (3) specimen signatures.
• Please do not sign if there are incomplete and invalid entries in the above boxes.
• Falsification or forgery of this form is a serious offense and will be meted with appropriate sanctions
