Office

of Student Affairs and Services

Student Organizations and Activities Unit

WAIVER

I am allowing my son/ daughter ____________Dennis E. Roldan___________

to join the organization namely ___________Exercise and Sports Society____________,
this Academic Year ____2022-2023_______.

I understand that the authorities of the Office of Student Affairs and Services of the
Southern Luzon State University exercise the necessary safety precautions in this activity.

In consideration of the benefits to be derived from his/her membership to the said

group, I expressly waive any and all claims against the administration or the faculty
adviser of the organization on account of unforeseen incident or injury that my
son/daughter might incur in joining the organization.

______Elena Roldan _____09 23-2022_____

Signature over printed name of Parents/Guardian Date

______DENNIS E. ROLDAN____ _____09-23-2022_____

Signature over printed name of Student Date

AA-OSAS-1.01F3, Rev.2