Adelina I Complex Elementary School

Adelina I Complex Elementary School Drum and Lyre

Genesis St. Adelina I Complex
San Antonio, San Pedro Laguna
Tel: 808-50-59

PARENTAL CONSENT AND WAIVER FORM

I, ________________________, grant permission for my son/daughter, _________________________________, to

(Parent/ Guardian’s Complete Name) (Complete Name of the student)
participate in Adelina I Complex Elementary School Drum and Lyre which requires fees for the music trainer (per session)
and uniform. I am informed that the Practice will be held on the following dates:
October 3 (Tuesday) 9am-12nn,
October 4 (Wednesday) 1pm-4pm and
October 6 (Friday) 1pm-4pm at Adelina I Complex Elementary Tennis Court.

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 Adelina I
Complex Elementary School, 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 or 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
school 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

Home Address: ____________________

Contact No(s): ____________________
 Adelina I Complex Elementary School
Adelina I Complex Elementary School Drum and Lyre
Genesis St. Adelina I Complex
San Antonio, San Pedro Laguna
Tel: 808-50-59

2 October 2017

Adelina I Complex Home Owners Association

Attention:
Mr. Arturo Acinas
Adelina I Complex Home Owners Association President

Sir/ Madam:

We, Adelina I Complex Elementary School Drum and Lyre group would like to ask permission to your good
office to allow us to use Adelina Tennis Court or the covered court whichever is available on the
following dates to conduct our practices.
October 3 (Tuesday) 9am-12nn,
October 4 (Wednesday) 1pm-4pm and
October 6 (Friday), 9am-12nn

The Band will be performing in the forthcoming SOBA of our Brgy Capt. Jun S. Ynion and other
community related performances.

Your favorable response regarding this request will be highly appreciated.

Thank you.

Respectfully yours,

AIZA D. PEDRIÑA
Adelina I Complex Elementary School
Drum and Lyre Coach

Noted by:

RENANTE R. SORIANO, Ed.D

Principal

Approved by: