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TY.
WAIVER
(Informed Consent)

I, (Name of the Student), (Age) years old, acknowledge that I wish to enroll in the (Name of
the Program) of ADNU.
I understand that I will participate in the Limited Face-to-Face Classes that will be conducted
by the Ateneo de Naga University.
I understand that certain risks are inherent in the conduct of the said classes in which I will
participate and I fully accept those risks. This risk includes, but not limited to, disease development. I
understand that there may be a great variety of other risks not known or reasonably foreseeable. I
acknowledge that Ateneo de Naga University is not responsible for any harm that might occur
arising from or connected to the face to face classes.
I acknowledge that I have to comply with the additional corroboration/s prior to enrolling in the
program and submit it/those to the Office of Student Affairs to ensure that I am fit to enroll/continue
the program.
I understand that once I am officially enrolled, the College/School will impart regular updates
to my parents/official guardian with regard to my academic standing, psycho-emotional and
physiologic well-being, and other pertinent information to ensure faithful supervision on me.
I understand that I have to perform other functions as may be defined related to compliance
with government regulations and issuances due to the fluid situation of the pandemic.
I fully release and discharge Ateneo de Naga University from all liability in connection with
my participation in the limited face-to-face classes.
In so making this waiver, I understand that I cannot commence an action against Ateneo de
Naga University and/or its officers, before any and all fora.

(SIGNATURE OVER PRINTED NAME OF STUDENT)

ACKNOWLEDGEMENT

Republic of the Philippines )

____________________________ ) S.S.
 

Before me, this _____ of ___________________, 2022 personally appeared 

(Signature over Printed Name of Student) (Signature over Printed Name of Parent/Official Guardian)

with government issued identification numbers (Government Issued Identification Number of the
student), (Government Issued Identification Number of Parent/Official Guardian), known to me to
be the same persons who executed this waiver/informed consent and who acknowledged to me that the
same is their free act and deed.

Witness my hand and seal.

 
Doc. no.: _____________
Page no.: _____________        Notary Public
Book no.: _____________
Series of: _____________