PAMANTASAN NG LUNGSOD NG MUNTINLUPA

University Road, Poblacion, Muntinlupa City

WAIVER
Date:

Knowing the benefits that ,

(Name of Student) (Course/Year and Section)
will derive from
(Activity)
to be held on in ,
(Day and Time) (Venue)

I hereby undertake to take the abovementioned activity as part of the course curriculum under my program.

My parents are aware that there are faculty members who will accompany us, and will take the necessary
precautions to keep us safe. However, if despite all efforts take any untoward incidents happened beyond the
control, without fault or negligence on the part of the Pamantasan ng Lungsod ng Muntinlupa (PLMun), PLMun
will not be held liable.

My parents are allowing me to join the said activity at the said venue in partial fulfillment of the
requirements for the course _________________________.

In view thereof, we hereby waive and free PLMun from any liability, or for any loss, damage, injury or
expenses that may be incurred in connection therewith.

Student’s Printed Name and Signature

Complete Address: _________________________

__________________________________________

Contact number: _________________

ID presented: __________________

CONFORME:

__________________________________________
Parent/Guardian’s Printed Name and Signature

Complete Address: ______________________________

__________________________________________________

Contact number: ________________________

ID presented: __________________

With Training Fee: ______ (To be paid directly to the resort)

Without Fee