REPUBLIC OF THE PHILIPPINES

ISABELA STATE UNIVERSITY

CITY OF ILAGAN, ISABELA
UAPSA - ISU
UNITED ARCHITECTS OF THE PHILIPPINES STUDENT AUXILIARY
ISABELA STATE UNIVERSITY - ILAGAN CAMPUS

Name of the Delegate:

Address:
Mobile Number:
Emergency Contact Person:

I, ___________________________________, hereby express my intention to join Project Kickstart organized by the

United Architects of the Philippines - Student Auxiliary to take place on November 16-17, 2023 at Isabela State
University - Ilagan Campus @gymnasium

In connection with the above-mentioned activity, I declare that:

 I take it as my responsibility to take the necessary precaution or care of avoiding getting involved in any incident
that would cause slight, serious, or mortal injury to any person or result in the loss or damage to my property and
that of another person.
 I understand that I am not to engage in any behavior that could or may lead to any incident or could result in loss
or damage to property, or injury to myself or other people.
 I understand that it is my responsibility to fully ascertain, if necessary with the help of a medical professional, my
physical and mental fitness to join this activity.
 I have properly informed and secured the consent of my parents or the person(s) exercising parental authority
over my person concerning the nature of the activity which I am joining.
 I have properly informed and secured the consent of my parents or the person(s) exercising parental authority
over my person concerning the nature of the activity which I am joining.
 I am fully convinced that the organization has exercised sufficient diligence and care in the preparation and
implementation of this activity.
 I understand that the United Architects of the Philippines Student Auxiliary is not liable for any unexpected
circumstances that may happen during the activity.

DECLARATION BY PARENT OR GUARDIAN

I, ____________________________, hereby fully endorse the above undertaking/declaration given by my child/ward.
And I will endeavor to induce my child/ward to do his/her best to observe the above-stated undertaking.

Parent/Guardian printed name and signature: ___________________________________

Date: ___________________________