WAIVER

(Must be Filled Handwritten)

To Whom It May Concern:

We, the undersigned parent of

student’s complete name
a student, of
year & course school’s complete name
hereby understand that the
name of physical sport
sport he/she will be joining voluntarily is a

necessary part of the 2023 CIVIL ENGINEERING MONTH CELEBRATION to be held at

Basic Education Campus, St. Paul University Surigao and Surigao Education Center on

November 28 to December 02, 2023 involves high intensity physical movement.

We hereby agree to answer for any damage that he/she may cause or suffer, and/or

liability that he/she may incur in connection with the said ACTIVITY and hereby absolve

his/her school, the Junior Philippine Institute of Civil Engineers – Surigao del Norte Chapter,

the Philippine Institute of Civil Engineers – Surigao del Norte (Mother Chapter), the

Philippine Institute of Civil Engineers, Inc., its members, officials or employees, for any such

damage or liability.

Father Mother
signature over printed name signature over printed name

Date

(This document must be filled up and be submitted to the Federated President for records keeping before the implementation date of the activity)