AFFIDAVIT OF UNDERTAKING

Republic of the Philippines)

_____________________ )S.S.
x--------------------------------------x

I, ____________________________________, of legal age, single/married,

Filipino citizen, and a resident of ________________________________________,
Philippines, after having been duly sworn in accordance with law hereby depose and
state, that:

I am a _____ student currently enrolled at the College of _______ of the West

Visayas State University located at Luna Street, Lapaz, Iloilo City;

As a_____ student, I will attend face-to-face classes at College at West Visayas

State University, Luna Street, Lapaz Iloilo City;

In the course of my class, I will be involved in activities including, but not limited
to the laboratory activities, skills development workshops,etc.;

I, with full knowledge of my parents/guardians understand the risks associated

with pursuing limited face-to-face classes at the WVSU education program;

I am fully aware, as my parents/guardians are fully aware, that, while the school
has implemented preventive measures in place to minimize health risks, to the students,
staff and faculty, it cannot eliminate all potential sources of COVID-19 infection;

I am likewise fully aware, together with my parents/guardians, that the risk of

becoming exposed to or be infected by COVID -19 may arise from the actions,
omissions, or negligence that I and/or others may commit/omit;

I undertake to be responsible for my own safety and well-being as well as that of

others, especially those with vulnerabilities while attending the limited face-to-face
classes;

I hold free and blameless West Visayas State University and any/or all the faculty
of the College from any liability should I contract any disease while I am in the
University campus or medical institution where I will be assigned.

I undertake to observe all prevailing health protocols imposed by the National

Government, the Local Government of Iloilo City, and the WVSU;
 I am executing this undertaking on my free will.

IN WITNESS WHEREOF, I have hereunto set my hand on this ____ day of

August, 2022 at _________________, Philippines.

(Name of Student)
Affiant
With my/our conformity:

_________________________
______________________________
(Printed name and signature of Parent/Guardian)

SUBSCRIBED AND SWORN to before me a Notary Public for

______________________on this ____ day of ______, 2022 at _________,
Philippines. Affiant/s personally appeared before me, signed the foregoing affidavit in
my presence and attested under oath as to the truthfulness of the contents therein. I
further identified them through competent proof of their identity/ies which are as follows:

Name Type of ID ID number Validity

and in my presence affirmed the facts in this foregoing document. Affiants manifested
that they voluntarily executed the affidavit; that they have read the same and
understood its contents and that the facts therein are true and correct to the best of their
personal knowledge.

Notary Public
Doc No. _____;
Page No. ____;
Book No. ____;
Series of 2022.