F2F Parental Consent and Waiver Form K To 12

TANAUAN INSTITUTE, INC.
– K-12 PROGRAM
PARENTAL CONSENT AND WAIVER FORM
Progressive Expansion of Face to Face Learning Modality, S.Y. 2022-2023
The Tanauan Institute – K-12 Program will be conducting a Progressive Expansion of Face to Face Learning Modality for
S.Y.2022-2023. This activity will be conducted in areas classified as minimal risk from COVID-19 and with reference to DepEd
Order No. 017, s. 2022, Guidelines on the Progressive Expansion of Face to Face Classes and DepEd-DOH Joint
Memorandum Circular (JMC) No.1, s. 2021, Operational Guidelines on the Implementation of Face to Face Learning
Modality.
Participation in this activity is voluntary. You or your child may decline to participate or to withdraw from participation at any
time for any reason. If you and your child decide to withdraw participation, kindly inform the teacher adviser of your child.
In accordance with the health and safety protocols in conducting the Progressive Expansion of Face to Face Learning Modality
the following should be understood:
Children who tested positive of COVID-19 or who have household members who tested positive of COVID-19 shall follow the
required quarantine period consistent with the latest national guidelines on Return to School/Work Policies and as provided in
Section 7.4.6 Strategy to Reintegrate of the Guidelines and must be cleared by a licensed medical doctor before they may
participate. The same applies to children who tested positive during the actual implementation.
RISKS, CONSENT WAIVER
As the parent or legal guardian of__________________________, I hereby acknowledge that I have been informed of the details
of the conduct of Progressive Expansion of Face-to-Face Learning Modality for SY 2022-2023.
I understand that Tanauan Institute shall implement the minimum public health standards set by the government to minimize risk
of the spread of COVID-19 but it cannot guarantee that my child will not become infected with COVID-19, given that COVID-
19 is highly contagious.
I understand that my child in-person attendance in school will include associating with teachers, fellow learners and school
personnel, and other persons inside and outside of the school that may put my child at risk of COVID-19 transmission,
notwithstanding the precautions undertaken by the school.
I acknowledge that my child participation in the Progressive Expansion of Face to Face Learning Modality is completely
voluntary. While there remains the risk of possible COVID-19 transmission to my child, and to the members of my household, I
freely assume the said risk and I permit my child to attend school under this activity.
I am aware that the symptoms of COVID-19 include, but are not limited to, fever or chills, cough, shortness of breath or
difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose,
nausea, vomiting, and diarrhea.
I confirm that my child currently has none of those symptoms, and is in good health. I will not allow my if my child to physically
go to school to attend the activity if my child or any member of my household develops any of the said symptoms or any other
symptoms of illness that may not be related to COVID-19. I will also inform the school and not allow my child to attend face to
face graduation if my child or any of my household members tests positive for COVID-19. My child and I, with my health
household members, will follow the required health and safety protocols and procedures adopted by the school and our
community.
To the extent allow by law and rules, I hereby agree to waive, release, and discharge any and all claims, causes of actions,
damages, and rights against the school and its personnel as well as officials and personnel of the Tanauan Institute relative to the
conduct of the Progressive Face to Face Classes.
With full understanding, I - on behalf of myself, my household members, and my child - hereby freely and voluntarily
give my consent to my child’s participation in the Progressive Expansion of Face to Face Classes this coming School Year
2022 to 2023 at Tanauan Institute, Inc., Tanauan City, Batangas. I also attest that I had sought the views of my child and
he/she has expressed willingness to participate in the Progressive Expansion of Face to Face Classes.
________________________________________ Date: ______________________________

Signature of Parent / Guardian over Printed Name
Address: ______________________________________________________________________
Contact Number: _______________________________________________________________
_________________________________________ Date: _______________________________

Signature of Student over Printed Name
Incoming Grade Level: _________________________________________________________

Address: ______________________________________________________________________
Contact Number: _________________
*Please submit this form to your child’s class adviser prior to the conduct of Progressive Face to Face Classes on
August 2022. Attach a copy of parent’s or guardian’s valid ID with signature. You may submit this form through
online or in printed copy.

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TANAUAN INSTITUTE, INC.

Progressive Expansion of Face to Face Learning Modality, S.Y. 2022-2023

RISKS, CONSENT WAIVER

__________ Date:

___________ Date: _

Incoming Grade Level: _________________________________________________________

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