Office

of Student Affairs & Services

Student Organizations and Activities Unit

WAIVER

I am allowing my son/ daughter Angelu P. Diolanda, to join the organization

namely Exercise and Sports Society, this Academic Year 2022-2023.

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

In consideration of the benefits to be derived from the derived from the above
activity, 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 connection with aforementioned activity.

Belen P. Diolanda
September 23, 2022
Signature over printed name of Date
Parents/ Guardian

Angelu P. Diolanda September 23, 2022

Signature over printed name of Date
Student

AA-OSA-1.01F7, Rev.1