PALAWAN STATE UNIVERSITY

PHILIPPINE INSTITUTE OF CIVIL ENGINEERS

STUDENT CHAPTER

PARENT/GUARDIAN CONSENT AND WAIVER OF LIABILITY

I, ______________________________, parent/guardian of ____________________________ (name

of Student) who is currently residing in ___________________________________________, voluntarily
allow him/ her to undergo in the Students’ Program/Activities particularly in Civil Engineering Sports and
Academic Olympiad 2022 at Palawan State University on ___________February 2-4,2023____________.

I understand that the Rules and Regulations established for the Students’ Program/Activities are
designed with due consideration of the safety and protection of the participants and hereby undertake to inform
my son/daughter to abide by the rules and regulations imposed by the University, and the policies and
guidelines which may be imposed by the University Student Government.

As PARENT/GUARDIAN of ___ _____________________________ (name of Student), I agree to

the following terms and conditions:

1. To bear the costs that will be incurred before, during, and after the Students’ Program/Activities.
2. To release Palawan State University, and all its officers and faculty from any claims whatsoever
arising or which may arise because the student participates in the Students’ Program/Activities
including any claims due to personal injuries or illness excepting any such claim resulting from
and/or arising out of the gross negligence of Palawan State University, its respective faculty,
officers and employees.
3. To authorize any representative of Palawan State University and/or any personnel of OSAS to
give medical attention for the student as may be deemed appropriate under the circumstances
should the student suffer injury or illness while on the program/activities, at our cost and hereby
releases Palawan State University, its respective faculty, officers and employees from any claim
arising out of such medical treatment;
4. Palawan State University may, in its discretion, terminate the student’s participation in the
Students’ Program/Activities should the student fail to keep and obey all rules and regulations
prescribed by Palawan State University and by the Philippine Institute of Civil Engineering –
Palawan State University Student Chapter while participating in the students’ program/activities.

I hereby acknowledge and permit the possible sharing of __ _________________________________

(the student’s name) personal information between Palawan State University and the Philippine Institute of
Civil Engineering – Palawan State University Student Chapter to process his/her academic and non-academic
requirements/documents. I hereby grant consent and allow my child to participate in the Students’ Program/
Activities, acknowledging all of the foregoing.

IN WITNESS WHEREOF, I have affirmed my signature hereunto this (date)

_____________________ in (address) __ _____________________________.

____________________________ ____
Name and Signature of Parent/Guardian

Conforme:

_________________________ DR. GRACE N. ABRINA

Name and Signature of Student Director, OSAS