De La Salle University - Manila

Civil Engineering Department

Parents’ / Guardian’s Certification of Waiver / Permission

for Student Exchange Visit in Tokyo Institute of Technology

This is to certify that I am allowing my son, John Gabriel A. Alon to go on a

Student Exchange Program for 10 days starting on May 7, 2018 until May 16,
2018 in Tokyo Institute of Technology.

It is understood that he abides by the rules and regulations that may be imposed by
the Supervisor/Staff-in-Charge for his welfare and safety.

I fully agree to waive any responsibility on the part of De La Salle University,

Tokyo Institute of Technology, and/or the representative/s, in case of any untoward
incident that may happen to my son during the duration of the practicum.

__________________________ ________________________
Name of Student Signature

__Marisol A. Alon __ ________________________

Name of Parent/Guardian Signature

________________________
Date of Submission