WAIVER OF LIABILITY AND ATTESTATION OF HEALTH CONDITION

I ______________________________, ____ years old, of legal age, single/married, with residence at

_______________________________ attest that:

1. I am a bona fide student at the Our Lady of Fatima University (OLFU) under the (College)
___________________________, year level _____ ;
2. I am aware that due to the lowering of the Alert level in Metro Manila OLFU has resumed face to
face classes in the University. I am also aware that despite the resumption of face to face
classes, OLFU still also offers alternative flexible learning for those who are at high risk or those
with comorbidity.
3. I am fully aware that I belong to the high risk with my comorbidity of
_____________________________________________________________ as attested by my
attending physician (attached medical clearance that my condition is managed, controlled, and
fit for face-to-face class).
4. Given my situation, I am fully aware of the risk attendant with face-to-face classes during this
pandemic.
5. I , with my parents, voluntarily and with full awareness of the possible health repercussions,
have decided to attend face to face classes in lieu of alternative flexible learning.
6. I warrant that I will attend classes with all necessary health protocols, following all protocols in
placed by OLFU, and ensuring that I do all things necessary to protect myself from possible
exposure.
7. I understand that OLFU has health protocols in place however this does not guarantee non-
exposure.
8. We fully release and discharge OLFU, its employees, officials, and Board of Directors, from all
liabilities in connection with my appeal to attend Limited Face to Face Class on campus.

____________________________ ______________________________
Student Signature Over Printed Name Parent’s Signature Over Printed Name
Date Signed:________________ Date Signed:________________
(Pls attached copy of Government Issued ID)

Witnessed by:

____________________________
Signature Over Printed Name
Date Signed:________________