Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur

PARENTS’ CONSENT AND WAIVER

I AM PERMITTING , who is my
(Name of Student: Family Name, Given Name, and Middle Name)
, enrolled in the University of Northern Philippines, Vigan City in the
(Relationship to the Student)
course to go on ACQUAINTANCE PARTY-CN WEEK 2023
(Course and Year) (Title of Activity)

With the following details:

• Place/Venue of Activity : UNP GYMNASIUM
• Date and Time of the Activity : October 25, 2023 (5:00 PM-10:00 PM)
• Name of Supervising Faculty Member :
• Contact Number of the Supervising Faculty Member :
• Amount of Contributions/ Payments (if any) : Php 250.00 (for food and lights)
• Diet Restrictions (if any): , present/Existing Ailment (if any):
• Objectives of the Activity:
1.
2.
3.
4.
IN THE EVENT THAT sustains damages by reason of
injuries or untoward events inflicted by an act of omission of himself/herself or by a fellow student or a
third party during the activity or while supervision or control is still present, I hold the supervising faculty
FREE from liability only when it is proven that he/she exercised or observed all the diligence of a good
father of the family to prevent the damage.
LASTLY, I hold the University or any officials free from any liability should it be proven that they
exercised the diligence of a good father of the family in the selection and supervision of its employees.
That I am of legal age and have read and understand the provisions of this consent and waiver that it is
binding upon me and the university.

ID Issued:
(Signature Over Printed Name of Parent/Guardian) ID Number:
(Date Signed)

REPUBLIC OF THE PHILIPPINES

CITY OF VIGAN…………………….) S.S.

SUBSCRIBED AND SWORN to before me this day of (Month & Year) at

Vigan City, Ilocos Sur exhibiting his/her identification indicated above his/her respective name and
signature.

Doc. No.
Page No.
Book No.
Series of 2023