Waiver of Liability

I, (Complete Name) Abby Paguio Manansala of legal age and a resident of (Complete Address) San
Vicente Apalit Pampanga is:

1. Undergoing Related Learning Experience in the affiliating hospital (Area Assignment) OPERATING
ROOM/DELIVERY ROOM (RLE duration) 1 WEEK;

2. I understand that given the current pandemic, there is a risk that I may contract SARS-COV-2 during
the RLE rotation at the OLFU CON Simulation/Virtual Laboratory. Despite this risk, I am willing to
undergo the RLE rotation which requires my physical presence within the premises of the OLFU CON;

3. Thereby hold OLFU CON NOT LIABLE from any claim, obligation or liability for accidents, injury, death
or other similar occurrences that may befall me during the period of my internship training.

4. I have read the entire waiver and understood its contents clearly and that the release, waiver, and
other undertakings hereby given have been made willingly and voluntarily with full knowledge of my
rights under the law;

5. I shall keep in confidence and not disclose, except only when authorized by law, the execution and
contents of this waiver; and

6. I am executing this waiver to attest to the truthfulness of the foregoing facts and for all legal intents
and purposes it may serve.

Signed this (Date) 30 of (Month) November , 2022.

Signature over Printed Name of Student Abby Paguio Manansala

Contact number(s): 09703267178

Person to contact in case of emergency: Harna Paguio Manansala

Contact information: 09264405871

Signature over Printed Name of Witness Harna Manansala

Relationship to Witness Mother