Office

of Student Affairs and Services

Student Organizations and Activities Unit

WAIVER

I am allowing my son/ daughter, Vienna Ailene I. Remperas to join the

organization namely THE WHEEL PUBLICATION, this Academic Year 2022-2023.

I understand that the authorities of the Office of Student Affairs and Services of
the Southern Luzon State University exercise the necessary safety precautions in this
activity.

In consideration of the benefits to be derived from his/her membership to the

said group, I expressly waive any and all claims against the administration or the faculty
adviser of the organization on account of unforeseen incident or injury that my
son/daughter might incur in joining the organization.

SERY I. REMPERAS September 10, 2022

Signature over printed name of Parents/Guardian Date

VIENNA AILENE I. REMPERAS September 10, 2022

Signature over printed name of Student Date

AA-OSAS-1.01F3, Rev.2