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Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
BUREAU OF JAIL MANAGEMENT AND PENOLOGY
REGIONAL OFFICE X
F. Delima St., Lumbia, Cagayan de Oro City
Tel# (088) 858-4137
Email address: bjmpprmd10@gmail.com

LIABILITY WAIVER
I, JO1 Applicant Rogie S. Macarandan, being aware of my own health and physical
condition, and having knowledge that my participation in any exercise program may be
injurious to my health, am voluntarily participating in a physical activity as part of the
recruitment process of the BJMP for Calendar Year 2022.

Having such knowledge, I hereby acknowledge this release, any representatives,

agents, and successors from liability for accidental injury or illness which I may incur as
a result of participating in the Strength and Agility Test. I hereby assume all risks
connected therewith and consent to participate the said activity.

I agree to disclose any physical limitations, disabilities, ailments, or impairments

which may affect my ability to participate in said activity.

Name: Rogie S. Macarandan Date of Birth: May 31, 1998

Address: Talacagan 1, Amoros, El Salvador City, Misamis Oriental

Mobile Number: 09751085315

Emergency Contact Person: Gilda S. Macarandan

Contact Number, in case of emergency: 09917437652

Signature: _______________________________________ Date: _______________________________

Witnessed by:

__________________________________________
SIGNATURE OVER PRINTED NAME

“Changing Lives, Building A Safer Nation”

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