Republic of the Philippines

SOUTHERN LUZON STATE UNIVERSITY

Lucban, Quezon

WAIVER

I am allowing my son/ daughter ________________________________________________ to

join the organization namely __________________________________________________________,
this School Year ___________________________.

I understand that the authorities of the Office of Student Services of the Southern Luzon State
University exercise the necessary safety precautions in this activity.

In consideration of the benefits to be derived from the derived from the above activity, I
expressly waive any and all claims against the administration or the faculty adviser of the organization
on account of unforeseen incident or injury that my son/daughter might incur in connection with
aforementioned activity.

______________________________ __________________
Signature over printed name of Date
Parents/ Guardian

______________________________ __________________
Signature over printed name of Date
Student

OSA FORM F, Rev.0