_____________________________

_____________________________

Dear Mr. / Mrs. ______________________________,

We would like to inform you that your son/daughter

____________________________________ will be part of the annual SPORTS FESTIVAL which
is to be undertaken by the DALUBHASAANG POLITEKNIKO NG LUNGSOD NG BALIWAG.
This event is for the BTECHENYOS; it is scheduled on _______________which will be held at
BALIWAG STAR ARENA, BRGY. PAGALA, BALIWAG CITY, BULACAN.

_________________________________________________________

WA I V E R FORM

Considering the benefits that my son/ daughter will derive from the above activity and further
considering the diligence to be exercised by the faculty/ coordinators there to ensure his/ her safety, I
shall hold the College, its faculty, personnel and staff free from any liability, claim, suit or action
from any unforeseen incident or any event beyond their control, not attributable to the negligence or
willful and deliberate act of the latter, or that arising from the student’s disregard or non-compliance
with rules, regulations and guidelines of the activity, as well as the precautionary measures taken by
the coordinator-in-charge.

____________________________________
Printed name and Signature of
Parent / Guardian
Address : ______________________________

______________________________ ____________________________________
Printed name and Signature of Student
Contact No. : _____________________________