UNIVERSITY OF SAINT ANTHONY

(Dr. Santiago G. Ortega Memorial)

City of Iriga

OFFICE OF THE STUDENT AND ALUMNI AFFAIRS

CONSENT AND WAIVER

OSAA ____________

This is to certify that I am allowing my son/daughter/ward,

_______________________________________________________________________
FIRST NAME MIDDLE INITIAL LAST NAME COURSE/YEAR

to join and participate in the ______________________________________________

ACTIVITY

_______________________________________________________________________
DEPARTMENT/ORGANIZATION

on __________________ __________________ __________________

DATE TIME CONTRIBUTION

I fully understand and agree that the University of Saint Anthony (USANT) shall
not be held liable for any untoward incident caused by my son’s/daughter’s/ward’s
negligence and recklessness and/or circumstances beyond the control of USANT.

Done this _______ day of __________, 2022 at _________________________.

________________________________
Parent’s/Guardian’s Signature
Over Printed Name
Contact number/s: _________________

Noted:

___________________________
Faculty Adviser’s/Dean’s Signature MRS. DAISY S. JUDAVAR
Over Printed Name Dean, Student and Alumni Affairs
USANT-F-OSAA-01 Rev.01 January 03, 2022