COLLEGE OF NURSING

WAIVER

I, parent/guardian of
(Parent’s / Guardian’s Name) (Student’s Name)
of the College of and a resident of
(College) (Residence)
do hereby waive my rights I have under Law for any injury that my son/daughter would suffer or incur

under circumstances beyond human control during

the
(Activity)
on at .
(Schedule Date and Time) (Place of Destination)

I hereby further absolve the Central Mindanao University and the admitting firm of whatever liability

he/she will encounter under the inclusive dates of the .

(Activity)

Parent’s / Guardian’s Signature

Over Printed Name
Date:

WITNESS: NOTARY PUBLIC

Doc. No. _____
Faculty In-Charge Page No. _____
Book No. _____
Series of _____
NOTED:

Dean/Principal

SUBSCRIBED AND SWORN to before me

day of , at Musuan, Maramag,
this
Bukidnon, affiant exhibiting to me his Community Tax Certificate/identification card indicated below
his name.

Note: Parent/guardian consent duly notarized before tour/trip; CMO No. 63 s. 2017
CMU-F-1-ACA-044 14 September 2020 Rev.0 Page 1 of 1
CMU-F-1-ACA-044 14 September 2020 Rev.0 Page 1 of 1