OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF CRIMINAL JUSTICE

Valenzuela Campus

WAIVER
(For Live Firing Examination)

KNOW ALL MEN BY THESE PRESENTS:

I, __________________________________________, ___ years old, presently residing at

___________________________________________, student of Our Lady of Fatima University,
College of Criminal Justice after having been duly sworn to according to law, do hereby depose and
say:

That, I personally enrolled the subject PECR 212 (Fundamentals of Marksmanship) / PEFS
212 (Firearms Proficiency) offered this 2nd semester of Academic Year 2022 – 2023.

That, I wish to gains knowledge and skills in firearms safety, experience practical shooting, by
way of performing practical shooting under the strict supervision of range officer at the certified
shooting range.

That PECR 212/PEFS 212 is part of my compliance pre-requisite for the completion of my
degree in Bachelor of Science in Criminology/Bachelor of Forensic Science.

That, I declare under oath that I am mentally, physically, emotionally and psychologically fit to
participate and perform activity covered in practical shooting.

That, I am releasing OUR LADY OF FATIMA UNIVERSITY, its Administrators, Faculty, PECR
212/PEFS 212 Instructor and Staff, and the Malabon Practical shooting Association Inc., (MPSAI), of
any responsibility for any and all injuries, sickness, death or losses that may be sustained by me
during the live firing examination.

That, I am releasing the University and the concerned firing range and gun club from any
Criminal or Civil Liability for any violation or illegal activities I may commit during the live firing
examination.

That, I am executing this waiver voluntarily, freely and fully of aware the contents of the same.

Signed this ___ day of 2023, at _________________________.

________________________________
(SIGNATURE OVER PRINTED NAME)

Conforme:

___________________________________
Signature above Printed Name of Parent/Legal Guardian
(with a machine copy of valid I.D. of
Parent/Guardian showing his/ her signature)

Signed in the presence of: _________________________

Witness