Republic of the Philippines Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

OFFICE OF THE STUDENT SERVICES/OSFA OFFICE OF THE STUDENT SERVICES/OSFA
RAGAY BRANCH RAGAY BRANCH
Ragay, Camarines Sur Ragay, Camarines Sur

WAIVER WAIVER

To whom it may concern, To whom it may concern,

I, ________________________________________ allowing my son/daughter I, ________________________________________ allowing my son/daughter

_________________________________, Bachelor ____________________________ _________________________________, Bachelor ____________________________
to attend the _________________________________________ on ______________. to attend the _________________________________________ on ______________.

That, I understand that necessary precautions have been taken to ascertain That, I understand that necessary precautions have been taken to ascertain
the safety and well-being of my son/daughter in the course of this travel and if anything, the safety and well-being of my son/daughter in the course of this travel and if anything,
arises from this activity beyond the University control waived all the claims against the arises from this activity beyond the University control waived all the claims against the
University and its official responsible for it. University and its official responsible for it.

______________________________ _____________________________
(Parent Printed name and Signature) (Parent Printed name and Signature)

_________________________________ _________________________________
(Student name and Signature) (Student name and Signature)

JOERWIN N. BALUTE, MBA JOERWIN N. BALUTE, MBA

Head, Student Services Head, Student Services