Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna
WAIVER
Date: 16 February 2024
To whom it may concern:
As the parent or guardian of:
(Name of the Student)
Department/Unit Sponsoring Activity: Supreme Student Council
Nature of the Activity: February Fair 2024: Sonic Rhythm Spectrum (Battle of the Bands)
Date of the Activity: February 16, 2024
Place of the Activity: Laguna State Polytechnic University Sta. Cruz Campus Activity Center
Time of the Activity: 06:00 PM to 05:00 AM
Faculty/Adviser/Staff-in-Charge: Samantha Jane Ponce Color

Together with my child, I know that Laguna State Polytechnic University and its officers, faculty, and staffs are expected to exercise
the legal diligence required for the safety and well-being of my child for the duration and the place, date and time of the activity as stated.
This legal diligence would include oral or written instructions whether given before or during the activity, that if followed, would
ensure the safety of my child.
If my child disregards or fails to follow those instructions or should act on his/her own, I together with my child, shall have no claims
against the school, its officers, faculty, adviser, staff-in-charge should any damage be caused or liability be incurred to property or person.

Respectfully yours,
of Parent/Guardian Contact Number:
of Student Contact Number:

LSPU-OSAS-SF-010 Rev.0 10 August 2016

Student Copy

Republic of the Philippines

Laguna State Polytechnic University
Province of Laguna
WAIVER
Date: 16 February 2024
To whom it may concern:
As the parent or guardian of:
(Name of the Student)
Department/Unit Sponsoring Activity: Supreme Student Council
Nature of the Activity: February Fair 2024: Sonic Rhythm Spectrum (Battle of the Bands)
Date of the Activity: February 16, 2024
Place of the Activity: Laguna State Polytechnic University Sta. Cruz Campus Activity Center
Time of the Activity: 06:00 PM to 05:00 AM
Faculty/Adviser/Staff-in-Charge: Samantha Jane Ponce Color

Together with my child, I know that Laguna State Polytechnic University and its officers, faculty, and staffs are expected to exercise
the legal diligence required for the safety and well-being of my child for the duration and the place, date and time of the activity as stated.
This legal diligence would include oral or written instructions whether given before or during the activity, that if followed, would
ensure the safety of my child.
If my child disregards or fails to follow those instructions or should act on his/her own, I together with my child, shall have no claims
against the school, its officers, faculty, adviser, staff-in-charge should any damage be caused or liability be incurred to property or person.

Respectfully yours,
of Parent/Guardian Contact Number:
Signature over Printed Name
of Student Contact Number:
Signature over Printed Name
LSPU-OSAS-SF-010 Rev.0 10 August 2016
Student Copy