URDANETA CITY

UNIVERSITY
Owned and operated by the City Government of Urdaneta COLLEGE OF CRIMINAL
JUSTICE EDUCATION

PARENTAL WAIVER AND RELEASE FORM

COLLEGE OF CRIMINAL
JUSTICE EDUCATION
COLLEGE OF CRIMINAL
I, Roland Velasquez, am the parent/guardian of JUSTICE EDUCATION
Romel Velasquez, who desires to participate in the following school activity:
COLLEGE OF CRIMINAL
JUSTICE EDUCATION
I acknowledge that I have been informed as to the nature of the activity and
the provisions for my child’s involvement and consent to my child’s
participation in the above described school activity.

In consideration of the permission granted to my child to participate in the

above described activity by Urdaneta City University, I do hereby waive,
release and hold harmless Urdaneta City University, it’s employees, and
officers, from any and all actions or causes of action of any nature for
personal injury or property damage of any kind arising in any way from my
child’s participation in the above described activity.

I further acknowledge that this release is binding upon my heirs, successors

or assigns, that I have read the foregoing and understand its significance, and
that I have executed this document voluntarily.

In witness whereof, I have signed this document on December 3, 2021

ROLAND C. VELASQUEZ
Parent/Guardian - Signature Over Printed Name

Address: 025 – E Aguila St. Amanoaoac Mapandan, Pangasinan

Telephone Number: 09276427242

Brightfuture starts here (075) 600-1507

San Vicente West, Urdaneta City, Pangasinan
ucu.edu.ph | univpresidentofficial@gmail.com