Document No.

WVSU-OSA-SOI-02-F02
PARENT’S PERMIT AND Issue No. 1
LIABILITY WAIVER
Revision No. 0
Date of Effectivity April 27, 2018
WEST VISAYAS STATE Issued by: OSA
UNIVERSITY Page no. Page 1 of 1

Alimodian, Iloilo
(Address)
033-397-3319
(Tel. No.)
10/25/22
(Date)
Prof.
(Name Cynthia
of Faculty L. Morga
In-Charge)

WVSU- University
(Section/Name Student
of Student Council
Organization)

Sir/Madam:

The undersigned requests that Bridget Camayra

(Name of Student)
be allowed to participate in Pag-irirmaw 2022
(Activity)
which shall be held at
WVSU Grounds - Grandstand & Football Field
(Place/Venue)
on (date) at (time)
October 28, 2022 8:00 AM- 8:30 PM
I have considered the benefits that my son/daughter may derive from his/her participation and/or the
experiences that he/she may gain from the activity, and that the school will not be liable for any untoward
incident that may happen to the student beyond their control during the duration of the activity.
JANNETTE A. CAMAYRA
(Signature of Parent/Guardian over printed name)

Note: for travels outside Western Visayas/ Educational Tours

REPUBLIC OF THE PHILIPPINES (

S.S)

BEFORE ME, Notary Public for and in the city and Province of ILOILO, this
at personally appeared with CTC No.
issued at on .

Known to me to be the same person who executed the forgoing instrument and they acknowledge that the
same in their free and voluntary act and deed.

WITNESS MY HAND AND SEAL

Notary Public

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