Ateneo de Zamboanga University

Office of Student Affairs

IN-CAMPUS ACTIVITY
PARENT’S CONSENT AND WAIVER FORM

WAIVER
NADEZHDA A. ESCRIBANO
I, BSAC - 3
a student of
(Name of Student) (Course & Year)
Ateneo de Zamboanga University will attend the ___________________AAO- JPIA
DAYS____________________
(Event)
September 22 to September 24, 2022, from 7:00 AM to 6:00 PM for Day 1 & Day 2, and from 7:00
AM to 8:00 PM for Day 3 at the _ Ateneo de Zamboanga University - Fr. Eusebio SJ
Campus.
(Date & Time) {Venue)
I fully understand the circumstances of joining and attending the event. Therefore, I do hereby
waive any liability, of whatever nature, be it civil, criminal or administrative against the Ateneo de
Zamboanga University and all concerned authorities for any untoward incident or any harm that
should befall me during my participation in the event.

NADEZH DA A. ESCRI BANO

__ __ __ _
Student’s Signature over Printed Name

***
CONSENT

D I ONSI O E .
I/We __ _ _ _
parent(s)/guardian(s)of N__ADEZHDA A__.
ES CR I BANO
_ __ _ _ ESCRI_BA_NO _
(Name of Parent(s)/Guardian) (Name of Student)
do hereby grant permission for his/her participation in the _AAO- JPIA DAYS_ on September
22 to September 24, 2022, from 7:00 AM to 6:00 PM for Day 1 & Day 2, and from 7:00 AM to 8:00
PM for Day 3 at the _ Ateneo de Zamboanga University - Fr. Eusebio SJ Campus.

I/We voluntarily waive our rights to claim against the concerned authorities and school of
whatever nature, be it civil, criminal or administrative. Should any untoward incident befall our
son/daughter/ward in the course of his/her participation and during his travel to and from the
said event.
DIONSIO E. ESCRIBANO
_
Parent’s/Guardian’s Signature over Printed Name
09/05/2 022
_ _ _
Date
NOTE: Any forgery on the Parent’s Consent and Waiver Form is considered a very serious offense as stipulated in the
ADZU College Student’s Handbook and may result to expulsion.
Please attach the scanned copy of your school ID and your parents ID.

SCHOOL ID

PARENT/GUARDIAN ID