POLYTECHNIC COLLEGE OF LA UNION

(Formerly PAMETS COLLEGES)

Don Pastor L. Panay Sr. Street, San Nicolas Sur, Agoo, La Union 2504
Tel. No. (072) 2061761 Mobile No. 09173223141 Email: pcluadmin@pclu.com.ph
https://www.facebook.com/PCLUBasicEducationDepartment
Twitter: @Official_PCLU Instagram: official_pclu
Member: Philippine Association of Colleges & Universities

STUDENT AFFAIRS OFFICE

School Year 2022-2023

Waiver and Release

In consideration of my involvement in the Basic Education Department, I, for myself, my heirs, executors and
assigns, do hereby release and discharge the Polytechnic College of La Union and its teaching staff/staff for any and all
claims and damages, demands or action whatsoever in any manner arising from or growing out of my joining in the
_______________ on November ___, 2022 at PCLU, Agoo, La Union.
I promise to follow the guidelines in the conduct of the _________________ including the health and safety
protocols being implemented by the school.

_______________________ _____________________________________________________________
Date Student's Signature over Printed Name

---------------------------------------------------------------------------------------------------------------------------------------------------

PARENT'S/GUARDIAN'S CONSENT

I hereby allow my son/daughter/ward _______________________________________ to join in the

_______________ on November ___, 2022 at PCLU, Agoo, La Union.
I am fully aware of the risk that my son/daughter may be exposed to for the duration of the aforementioned
activity. I, therefore, release the Polytechnic College of La Union and its teaching staff/staff from any responsibility and
all injuries, losses, infection of diseases that may be sustained by our son/daughter/ward during the event.

_______________________ _____________________________________________________________
Date Parent's Signature over Printed Name