Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
Tel no.: (054) 288-4421 to 23 (loc.122)

STUDENT AFFAIRS AND SERVICES OFFICE

Liability Release Form

I, BARRAMEDA ALVIN JOHN B ,

Name of student
BSN – 2H

Program-year and section

College/Buhi Campus

BADMINTON NNHS
Event Venue of practice

hereby assume all of the risks of participating in any of the activities associated with this event
– The 2022 CSPC Intramurals. I acknowledge that this Accident Waiver and Release of Liability
Form will be used by the Administration and organizers of the activity in which I may participate and
that it will govern my actions and responsibilities at said activity.

In consideration of my permission to participate in this activity, I hereby take action for myself, and
agree to in no way hold Camarines Sur Polytechnic Colleges, and its employees and students
responsible for any accident, injury, property damage or death occurring to me as the result of my
participation to practices and travel to and from Camarines Sur Polytechnic Colleges, Nabua, Camarines
Sur on October 24, 2022 to November 05, 2022 at 04:00 PM to 10:00 PM. Further, I am aware that I
will be attending practices within the premises of Camarines Sur Polytechnic Colleges
(CSPC) at my own risk.

I CERTIFY THAT I HAVE READ, UNDERSTOOD THIS DOCUMENT AND I FULLY

UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY
AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

10-28-22 ALVIN JOHN BARRAMEDA 20

Participant’s Signature Date Participant’s Name Age

(Please print legibly.)

Parent/Guardian Signature Date

(If under 18 years old, Parent or Guardian must also sign.)