Republic of the Philippines

DEPARTMENT OF EDUCATION
REGION I
SCHOOL DIVISION OFFICE URDANETA CITY
LYCEUM NORTHWESTERN UNIVERSITY
Nancayasan, Urdaneta City, Pangasinan

Date :__________________

This is to allow my son/daughter/ward_____________________________________, a student in the

Basic Education, Senior High School Department, Lyceum – Northwestern University, Urdaneta City to
have his/her assessment/training, on the requested date on October 4, 2020 onwards in ____________
____________________________________________, during Saturday and Sunday. It is for the
students in order to finish their trainings /assessment in NCll.

That I waive my right to claim for any liabilities against the Lyceum – Northwestern University, in any
untoward incident beyond normal control that may befall on son/daughter/ward in connection with the
said activity

Signed this ___________ day of __________ at ____________________________________.

______________________________ ______________________________
Signature over Printed Name Signature over Printed Name
Of Student Of Parent/ Guardian

* As per University policy, the accomplishment of this waiver is NOT tantamount to approved of the
activity but is a requirement PRIOR TO ACTIVITY APPROVAL.

Republic of the Philippines

DEPARTMENT OF EDUCATION
REGION I
SCHOOL DIVISION OFFICE URDANETA CITY
LYCEUM NORTHWESTERN UNIVERSITY
Nancayasan, Urdaneta City, Pangasinan

Date :__________________

This is to allow my son/daughter/ward_____________________________________, a student in the

Basic Education, Senior High School Department, Lyceum – Northwestern University, Urdaneta City to
have his/her assessment/training, on the requested date on October 4, onwards ___________________
____________________________________________, during Saturday to Sunday. It is for the students
in order to finish their trainings /assessment in NCll.

That I waive my right to claim for any liabilities against the Lyceum – Northwestern University, in any
untoward incident beyond normal control that may befall on son/daughter/ward in connection with the
said activity

Signed this ___________ day of __________ at ____________________________________.

______________________________ ______________________________
Signature over Printed Name Signature over Printed Name
Of Student Of Parent/ Guardian

* As per University policy, the accomplishment of this waiver is NOT tantamount to approved of the
 Republic of the Philippines
DEPARTMENT OF EDUCATION
REGION I
SCHOOL DIVISION OFFICE URDANETA CITY
LYCEUM NORTHWESTERN UNIVERSITY
Nancayasan, Urdaneta City, Pangasinan

activity but is a requirement PRIOR TO ACTIVITY APPROVAL.