Document No.

WVSU-OSA-SOI-02-F02
PARENT’S PERMIT AND
Issue No. 1
LIABILITY WAIVER
Revision No. 0
Date of Effectivity April 27, 2018
WEST VISAYAS STATE
Issued by: OSA
UNIVERSITY
Page no. Page 1 of 1
La Paz Gustilo, Iloilo
(Address)
0344365491
(Tel. No.)
November 8, 2022
(Date)
PROF. VOLTAIRE B. JACINTO
(Name of Faculty In-Charge)
POLITICAL SCIENCE STUDENT'S ORGANIZATION
(Section/Name of Student Organization)

Sir/Madam:
ERICAH M. VILLACARLOS
The undersigned requests that
(Name of Student)
be allowed to participate in PSSO EUPHORIA ACQUAINTANCE PARTY AND GENERAL ASSEMBLY
(Activity)
which shall be held at COLLEGE OF MEDICINE GYMNASIUM
(Place/Venue)
3:30- 7:00 PM
on (date) NOVEMBER 11,2022 at (time)

I have considered the benefits that my son/daughter may derive from his/her participation
and/or the experiences that he/she may gain from the activity, and that the school will not be liable for
any untoward incident that may happen to the student beyond their control during the duration of the
activity.
CHERYL M. VILLACARLOS
(Signature of Parent/Guardian over printed name)

Note: for travels outside Western Visayas/ Educational Tours

REPUBLIC OF THE PHILIPPINES

( S.S)

BEFORE ME, Notary Public for and in the city and Province of ILOILO, this ______________
at personally appeared with CTC No. ___________
issued at on .

Known to me to be the same person who executed the forgoing instrument and they
acknowledge that the same in their free and voluntary act and deed.

WITNESS MY HAND AND SEAL

Notary Public

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