Our Lady of Miraculous Medal Chapel

West Visayas State University Medical Center

Jaro, Iloilo City, Philippines 5000
Flores de Mayo Registration Form

Name: _________________________________________________ Sex: M F

Age : ____________ Grade Level : ______________ School : ________________________

Parent’s/ Guardian’s Name : ______________________ Contact Number: ______________

___________________________________________________________________________

Waiver

This is to certify that I am allowing my son/daughter to join the Flores de Mayo from May 1- 31 from
Monday to Saturday every 2 PM . It is understood that my son/daughter shall abide by the rules and
regulations that may be imposed by Our Lady of Miraculous Medal Chapel for the welfare and safety of
the group. It is further understood that I fully agree to waive any responsibility on the part of the Chapel
and personnel-in-charge in case any untoward incident happens to my son/daughter during the entire
duration of this activity.

___________________________________

Parent’s/ Guardian’s signature over printed name

Our Lady of Miraculous Medal Chapel

West Visayas State University Medical Center
Jaro, Iloilo City, Philippines 5000
Flores de Mayo Registration Form

Name: _________________________________________________ Sex: M F

Age : ____________ Grade Level : ______________ School : ________________________

Parent’s/ Guardian’s Name : ______________________ Contact Number: ______________

___________________________________________________________________________

Waiver

This is to certify that I am allowing my son/daughter to join the Flores de Mayo from May 1- 31 from
Monday to Saturday every 2 PM . It is understood that my son/daughter shall abide by the rules and
regulations that may be imposed by Our Lady of Miraculous Medal Chapel for the welfare and safety of
the group. It is further understood that I fully agree to waive any responsibility on the part of the Chapel
and personnel-in-charge in case any untoward incident happens to my son/daughter during the entire
duration of this activity.

___________________________________

Parent’s/ Guardian’s signature over printed name