NORTHWESTERN UNIVERSITY

Laoag City

LIABILITY WAIVER AND UNDERTAKING OF STUDENTS

Republic of the Philippines )

City of Laoag) SS.

LIABILITY WAIVER AND UNDERTAKING OF STUDENTS

I, JANN ENRICO A. GAPPI, of legal age, a resident of #17 NAGCALAOAN TABUG

BATAC CITY, ILOCOS NORTE and a student of Bachelor of Science in Marine
Engineering/Transportation of Northwestern University, College of Maritime Education, after having
been duly sworn to in accordance with law, do hereby depose and state, THAT:

1. I am fully aware that the limited Face-to-Face (F2F) Classes and Internship is part and parcel
of the academic requirements for my course;
2. I have been made aware of the guidelines set forth under Joint Memorandum Circular No.
2021-004 of the Commission on Higher Education and the Department of Health; as well as
the policies, rules and regulations on the Conduct of Limited Face-To-Face (F2F) Classes and
Internship Students During the Pandemic Period as attached in this undertaking;
3. I undertake to abide by the rules and regulations set forth under Joint Memorandum Circular
No. 2021-004 of the Commission on Higher Education and the Department of Health; as well
as the policies, rules and regulations on the Conduct of Limited Face-To-Face (F2F) Classes
and Internship Students During the Pandemic Period, particularly the preparation and the
conduct of the F2F Classes and Internship;
4. I am also fully aware that I have the option not to participate in the F2F Classes and
Internship and may instead finish via flexible online learning and that it is my decision to
participate in the F2F, and, as such, there are risks of contracting diseases, including COVID-
19, in the course of the said activities;
5. Further, I declare that I do not have any co-morbidities (e.g. asthma, hypertension, diabetes,
obesity) that may put me at greater risk in contracting COVID-19.

IN WITNESS WHEREOF, I hereunto affix my signature this _____________________ in

the City of Laoag, Province of Ilocos Norte.

JANN ENRICO A. GAPPI

Printed Name & Signature of Student

SUBSCRIBED AND SWORN TO before me this _____________________ in the City of

Laoag, Province of Ilocos Norte. Affiant exhibiting to me his/her ID
________________________________ with ID No. ____________________ issued on
_________________________ at _______________________.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of _______.
 NORTHWESTERN UNIVERSITY
Laoag City
LETTER OF CONSENT OF PARENTS

Republic of the Philippines)

City of Laoag) SS.

LETTER OF CONSENT OF PARENTS

I, LORD S. GAPPI, of legal age, a resident of #17 NAGCALAOAN TABUG BATAC

CITY, ILOCOS NORTE, after having been duly sworn to in accordance with law, do hereby depose
and state, THAT:

1. I am the parent/ guardian of JANN ENRICO A. GAPPI, a student of Bachelor of Science in

Marine Engineering/Transportation of Northwestern University, College of Maritime
Education,
2. I am fully aware that the limited Face-to-Face (F2F) Classes and Internship is part and parcel
of the academic requirements for my son/daughter/ward’s course;
3. I have been made aware of the guidelines set forth under Joint Memorandum Circular No.
2021-004 of the Commission on Higher Education and the Department of Health; as well as
the policies, rules and regulations on the Conduct of Limited Face-To-Face (F2F) Classes and
Internship Students During the Pandemic Period as attached in this undertaking;
4. I am also fully aware that I have the option not to allow my son/daughter/ward in the F2F
Classes and Internship and may instead finish via flexible online learning;
5. I understand that there are risks of contracting diseases, including COVID-19, involved in the
participation of my son/daughter/ward in the F2F classes/internship;
6. Further, my son/daughter/ward does not have any co-morbidities (e.g. asthma, hypertension,
diabetes, obesity) that may put him/her at greater risk in contracting COVID-19.

IN WITNESS WHEREOF, I hereunto affix my signature this _____________________ in

the City of Laoag, Province of Ilocos Norte.

LORD S. GAPPI
Printed Name & Signature of Parent/Guardian

SUBSCRIBED AND SWORN TO before me this _____________________ in the City of

Laoag, Province of Ilocos Norte. Affiant exhibiting to me his/her ID
________________________________ with ID No. ____________________ issued on
_________________________ at _______________________.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of _______.