CONCEPCION HOLY CROSS COLLEGE INC.

BSHRM IV
Off-campus Seminar Trip Waiver and Permission Agreement

In consideration of Concepcion Holy Cross Colleges permitting:

Students Name: _____________________________________, to participate in the OffCampus

Seminar Trip to Mushroom Technology Office at Paraiso, San Miguel, Tarlac City on Wednesday,
20th September 2017 to depart at 6:30 a.m. and to return at 3:00 p.m. Wednesday, on the same, at
no cost, meaning FREE OF CHARGE by the sponsorship of the government office mentioned.
The undersigned hereby releases Concepcion Holy Cross Colleges, its respective directors,
officers and the Instructor of and from any and all claims whatsoever arising or which may arise
by reason of the students participation in the Off-Campus-Seminar Trip including any claims due
to personal injuries or illness excepting any such claim resulting from and/or arising out of the
gross negligence of Concepcion Holy Cross Colleges.

Should the Student suffer injury or illness while on the Off-School Seminar Trip, the undersigned
hereby authorizes any representative of Concepcion Hoy Cross College and, in particular, their
Instructor accompanying the Student to authorize such medical attention for the Student as may
be deemed appropriate by said representative of Concepcion Holy Cross Colleges in the
circumstances. The undersigned agrees to bear the costs of all medical care and procedures
required by the Student. The undersigned also agrees to maintain appropriate medical insurance
coverage for the Student while on the Seminar Trip.

The undersigned hereby releases Concepcion Holy Cross Colleges, its respective directors,
officers and faculty from any claim arising out of any medical treatment the Student may require.

The undersigned acknowledges that should the Student fail to keep and obey all rules and
regulations prescribed by Concepcion Holy Cross College, its respective directors, officers and
faculty, while participating in the Off-Campus Seminar Trip, Concepcion Holy Cross Colleges may,
in its sole and absolute discretion, terminate the Students participation in the Seminar Trip. In the
case of a day trip, it is unlikely that the Student would be returned to school. Were this to occur,
the Student would return in the company of the member of the faculty. Any additional costs
incurred by reason of the termination of the Students participation in the whole day Seminar Trip
and/or as a result of the Student being sent home will be the responsibility of the undersigned.

PLEASE CHECK ONE BOX, DATE AND SIGN BELOW

I have carefully read this Waiver and Permission Agreement and understand the terms and
conditions of it and agree to be bound thereby. The Student has the undersigneds permission to
participate in the Off-Campus Seminar Trip.

Signature of Parent or Guardian: ____________________________ Date: _______________

The Child will not participate in this Field Trip.

Signature of Parent or Guardian: ____________________________ Date: _______________

PLEASE ENSURE THAT YOUR CHILD RETURNS THIS FORM TO THE REGISTRARS OFFICE
NO LATER THAN TUESDAY, 19th SEPTEMBER 2017