Ateneo de Zamboanga University

College of Science, Information Technology and Engineering

(062) 991-0871 local fb.com/adzucsi
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ACKNOWLEDGEMENT AND WAIVER FOR FACE-TO-FACE ACTIVITIES

I acknowledge that, through CHED Memorandum Order 09 S 2022, ADZU have issued guidelines
to best prevent the transmission and infection of COVID during the conduct of face-to-face classes and
off-campus activities for the completion of course requirements. I am fully aware of such guidelines, and I
shall strictly comply with the established directives and protocols to protect myself and others from
substantial risks posed by COVID-19. I shall also apply suggested standard practices in preventing COVID
19 transmission and infection.

I am cognizant of the serious risk of contracting COVID-19 while attending limited face-to-face
classes and other activities. I understand that such guidelines do not absolutely guarantee that the risk of
COVID-19 transmission is fully eliminated. Notwithstanding the possible risks that I am exposed to, I
willfully and voluntarily attend and participate in ADZU’s limited face-to face classes and activities.

I thus assume full responsibility for any sickness, disability, injury, harm, damage, or death that
may arise from my willful action or negligence during the conduct of ADZU's limited face-to-face classes
and activities. Accordingly, exercising due care, I release ADZU including its Board of Trustees, officials,
administrators, faculty and staff, from any and all responsibility and liability for such. Any claim, action,
dispute, complaint, or issue related to the conduct of face-to-face classes and activities must first be
presented to ADZU administration for proper disposition and settlement.

I understand that I must inform, report to and consult with the Infirmary and school
administration when I have medical or health concerns, particularly when I exhibit any COVID-19
symptoms. I must likewise truthfully and completely disclose pertinent and relevant facts and information
related to my medical or health condition or history. Upon evaluation, ADZU may implement reasonable
isolation and quarantine protocols, suspend the conduct of face-to-face classes and activities, and
prevent any student from attending and participating in such classes and activities to diminish the risk of
COVID-19 infection and transmission.

I acknowledge that ADZU may institute disciplinary action and impose sanctions such as
suspension or dismissal from the university among others in accordance with the ADZU College of
Science, Information Technology and Engineering Guidelines and/or the student handbook if I fail to
comply with and/or violate the prescribed guidelines and protocols enacted by the university or other
government entities (IATF, CHED, LGU, etc.). ADZU reserves the right to revoke the privilege of
participating in face-to-face classes and activities and being able to physically access campus facilities to
protect the health, security and safety of its students, faculty and staff.

If at any point, I am unable to faithfully abide by the prescribed guidelines and sustain these
commitments because of any physical or psychological impairment or for any other reason, I shall
voluntarily remove myself from participating in face-to-face classes and other activities, and finish the
semester remotely.

I execute this acknowledgement and waiver freely and voluntarily, and shall faithfully abide by
the stipulations herein, fully aware of the consequences of any willful violation and negligence in
complying with the terms of this undertaking.

Name of the Student and Signature / Age / Civil Status / Residence:

Philwin M. Hao / 22 / Single/ Km.4 Pasonanca Zamboanga City

Date Signed: 1/14/2022

Conforme:

Name and Signature of Parent: Milagros M. Hao

Date Signed: 1/14/2022

Witness :
Name and Signature: Louie Virgil A Gallardo Date Signed: _____________

COMPUTER SCIENCE DEPARTMENT | ENGINEERING DEPARTMENT | MATHEMATICS DEPARTMENT |

NATURAL SCIENCES DEPARTMENT