SPORTS OFFICE

OFFICE OF THE SPORTS OFFICE

ASSUMPTION OF RISK AND WAIVER

_________________
Date
TO WHOM IT MAY CONCERN:

This is to certify that I allow my son/ daughter _____________________________, College

of _________________________, Section_____________to attend the
__________________________
on__________________at__________________________.

Therefore, I, the student, and we, the parents/guardians, hereby assume the risk of injury
and damaged cause by any accident or untoward event or occurrence arising in the course of
activity, and the University, as well as any of its employees or agents, are hereby declared free and
harmless from all claims, liabilities, and demands of any kind and nature by reason of such injury and
damage.

Accordingly, we hereby affix our signatures this _____________ day of ____________

20____ in the City of Iloilo, Philippines.

__________________________________________
Printed Name & Signature of Father/ Mother/
Guardian

____________________________________________
Printed Name & Signature of Student

120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA

Contact No.: 0929-761-8651 |Fax No.: (033) 337-4403

Email: sports@usa.edu.ph | Website: www.usa.edu.ph