Avccd Waiver

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WAIVER FORM FOR UNDERGRADUATE STUDENT

_______________________
Date

De La Salle University
Taft Avenue, Manila

Gentlemen:

As the parent/guardian of _____________________________, with ID No.


____________________, I allow my son/daughter to join and participate in:

Department/Unit Sponsoring Activity : ____________________________


Nature of Activity : ____________________________
Date of Activity : ____________________________
Place of Activity : ____________________________
Time of Activity From: ______________ : ____________________________
Faculty/Adviser/Staff-in-Charge : ____________________________

Together with my child, I know that the University and its officers, faculty and staff
are expected to exercise the legal diligence required for the safety and well-being of my child
for the duration and place, date and time of the activity as stated

This legal diligence would include oral or written instructions, whether given before
or during the activity, that if followed, would ensure the safety of my child.

If the child disregards or fails to follow those instructions or should act on his/her
own, I, together with the child, shall have no claim against the University, its officers,
faculty, adviser, staff-in-charge should any damage he caused or liability be incurred to
property or person.

I also acknowledge that clinic hours are from 7:00am to 9:30pm on Monday to Friday
and from 7:00am to 7:00pm on Saturday.

Very Truly Yours,

__________________________________ _______________________________
(Name & Signature of Parent) (Contact Number)

__________________________________ _______________________________
(Name & Signature of Student) (Contact Number)

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