Republic of the Philippines

President Ramon Magsaysay State University

(Formerly Ramon Magsaysay Technological University)
Iba, Zambales Philippines 2201
Telfax: 047-811-1683
www.prmsu.edu.ph

Student’s Information
Student Name (Last, First, Middle): ________________________________________________
Course, Year, and Section: ________________________________________________________
Contact No.: ___________________________ Email: ______________________________
Organization & Position: _________________________________________________________
Date of Birth: ____________________________________
Address: ______________________________________________________________________
Sex: (___) M (___) F
In case of emergency, Please contact
Parent/Guardian: ______________________________________ Contact No.: ______________

WAIVER

I, parent/guardian of ___________________________________________ hereby permitted my

son/daughter to attend the _______________________________________________________
_____________________________________________________________________________
after considering the benefits that my son/daughter will derive from his/her participation.
Moreover, it is expected that the event organizers will take all necessary precautions during the
conduct of the said activity to ensure the safety and security of my son/daughter. However, I will
not hold the event organizers accountable for any untoward incident resulting from
circumstances beyond their control.

______________________________________ ________________________
Signature over Printed name of Parent/Guardian Date

*Note: Please attach a Photocopy/Scanned copy of Parent/Guardian’s Identification Card with

picture and 3 specimen signatures.