Waiver for Entering Negros Oriental State University (NORSU) Despite Unvaccinated/Partially Vaccinated Status 1

I, ____________________________________________, hereby acknowledge that I am of the following status (Please Check):

(First Name, Middle Initial, Last Name)

______ Not vaccinated with anti-COVID-19 Vaccine ______ Partially Vaccinated with anti-COVID-19 Vaccine

I am fully aware that I may expose myself to increased possibility of contracting COVID-19 infections if I am not vaccinated/partially
vaccinated when I am physically present inside the university to do my transactions or be involved in face-to-face classes/activities. I
have fully understood the risks involved to my health and fully aware that it may endanger my life. However, despite all these, I
voluntarily sign and decide to do my transaction inside the university physically via face-to-face or be part of face-to-face
classes/activities. I am telling the truth and I am fully and personally responsible for my own safety and actions during my presence
at/inside the university and release the university campus from any liability that may arise of my decision/s.

Days to be Present inside the University Campus (Pls specify date/s or Date Range): ______________________________________

____________________________________________________________
Signature of Individual/Student/Employee/Guardian or Parent/Guest

Date Signed: ______________

--------------------Pls Cut Here------------------------ Pls Cut Here ----------------------------- Pls Cut Here ----------------------

Waiver for Entering Negros Oriental State University (NORSU) Despite Unvaccinated/Partially Vaccinated Status 1

I, ____________________________________________, hereby acknowledge that I am of the following status (Please Check):

(First Name, Middle Initial, Last Name)

______ Not vaccinated with anti-COVID-19 Vaccine ______ Partially Vaccinated with anti-COVID-19 Vaccine

I am fully aware that I may expose myself to increased possibility of contracting COVID-19 infections if I am not vaccinated/partially
vaccinated when I am physically present inside the university to do my transactions or be involved in face-to-face classes/activities. I
have fully understood the risks involved to my health and fully aware that it may endanger my life. However, despite all these, I
voluntarily sign and decide to do my transaction inside the university physically via face-to-face or be part of face-to-face
classes/activities. I am telling the truth and I am fully and personally responsible for my own safety and actions during my presence
at/ inside the university and release the university campus from any liability that may arise of my decision/s.

Days to be Present inside the University Campus (Pls specify date/s or Date Range): ______________________________________

____________________________________________________________
Signature of Individual/Student/Employee/Guardian or Parent/Guest

Date Signed: ______________

--------------------Pls Cut Here------------------------ Pls Cut Here ----------------------------- Pls Cut Here ----------------------

Waiver for Entering Negros Oriental State University (NORSU) Despite Unvaccinated/Partially Vaccinated Status 1

I, ____________________________________________, hereby acknowledge that I am of the following status (Please Check):

(First Name, Middle Initial, Last Name)

______ Not vaccinated with anti-COVID-19 Vaccine ______ Partially Vaccinated with anti-COVID-19 Vaccine

I am fully aware that I may expose myself to increased possibility of contracting COVID-19 infections if I am not vaccinated/partially
vaccinated when I am physically present inside the university to do my transactions or be involved in face-to-face classes/activities. I
have fully understood the risks involved to my health and fully aware that it may endanger my life. However, despite all these, I
voluntarily sign and decide to do my transaction inside the university physically via face-to-face or be part of face-to-face
classes/activities. I am telling the truth and I am fully and personally responsible for my own safety and actions during my presence
at/ inside the university and release the university campus from any liability that may arise of my decision/s.

Days to be Present inside the University Campus (Pls specify date/s or Date Range): ______________________________________

____________________________________________________________
Signature of Individual/Student/Employee/Guardian or Parent/Guest

Date Signed: ______________