Republic of the Philippines

PALAWAN STATE UNIVERSITY

Tiniguiban Heights, Puerto Princesa City

WAIVER

I, the undersigned parent and/or legal guardian of

________________________________________, do hereby consent his/her
participation in the ________________________________________ to be held on
____________________ in ________________________________________.

I understand that there might be unforeseen circumstances or if foreseen, the

same may be inevitable, during the event. In addition to giving my full consent for
his/her participation to the said event, I do hereby waive, release, and hold harmless the
Palawan State University, its administration, officers, officials and/or employees, for any
circumstances which are inevitable and unforeseen that may arise during the whole
duration, including travel time to and from the event, and for any damages, which I or
the student-participant may suffer, or for which the student-participant may be liable to
other person/s and/or institution/s, related to the student’s participation in the event,
resulting from the any causes, including but not limited to the negligence on the part of
the student or any of the released parties.

IN SIGNING THE WAIVER, I acknowledge and represent that i have read the
foregoing waiver.

IN WITNESS WHEREOF, I have hereunto voluntarily set my hand this

____________________ (date) in ________________________________________
Philippines (location).

__________________________________________
(Parent and/or guardian signature over printed name)

Signed in the presence of:

________________________ ________________________
(Signature over printed name) (Signature over printed name)