F-SAEP-06

WAIVER FOR OFF CAMPUS STUDENT ACTIVITIES

Date: 10-27-23

To _____________________,

As parent/guardian of Kirsten Jannika G. Villena, BS LM 4-1

( Name of Student ) ( Course/Year/Section )
I allow my son/daughter to join and participate in the ______________________________________________________
(Title of Activity)
DETAILS OF THE ACTIVITY
Department
Objectives of the Activity

Date and Place of the Activity 1-5PM , UB Lipa

Time and Place of Departure
Time and Place of Arrival
Faculty/Adviser/Staff-in-Charge
Contact Number of Person-in-Charge

I, including my child, know that the University and its officers, faculty and staff have exercised the required
diligence for the safety and well-being of my child for the duration, place, date and time of the activity.

This includes oral/written instructions given before or during the activity which if followed, would ensure the safety
of my child.

If my child fails or willfully disregards to follow the provided instructions or should act on his/her own, we shall
have no claims against the University, its officers, faculty advisers and staff-in-charge should any damage be caused by
or liability incurred to any person or property.

Very truly yours,

Revision No.: 1 Issue Date: June 15, 2022 Revision Date: June 07, 2022
F-SAEP-06

Name and Signature of Parent/ Guardian Contact Number

Name and Signature of Student Contact Number

For the student concerned:

1. Please accomplish in duplicate. (One (1) for Academic Department and One (1) for SAEP Office)

Note: To be submitted to the Staff/Faculty-in-charge at least 2 days before scheduled activity.

Revision No.: 1 Issue Date: June 15, 2022 Revision Date: June 07, 2022
F-SAEP-06

By accomplishing the form I, as the data subject, hereby give my

consent and authorize University of Batangas specifically the SAEP Office to use my information solely for this activity.
This consent and authorization remains valid and subsisting for one (1) year and consistent with the purposes above or
until I revoked or cancelled
my consent / authorization in writing.

Revision No.: 1 Issue Date: June 15, 2022 Revision Date: June 07, 2022