Republic of the Philippines

PALAWAN STATE UNIVERSITY

Tiniguiban Heights, Puerto Princesa City

WAIVER

I, the undersigned parent and/or legal guardian of ______________________(name

of student), do hereby consent his/her participation in the
________________________________________________(title of the activity) to be held
on ____________________(duration) in _________________________________(location).

I understand that there might be unforeseen circumstances or if foreseen, the same

may be inevitable, during the event. In addition to giving my full consent for his/her
participation to the said event, I do hereby waive, release, and hold harmless the Palawan
State University, its administration, officers, officials and/or employees, for any
circumstances which are inevitable and unforeseen that may arise during the whole duration,
including travel time to and from the event, and for any damages, which I or the student-
participant may suffer, or for which the student-participant may be liable to other person/s
and/or institution/s, related to the student’s participation in the event, resulting from an
causes, including but not limited to the negligence on the part of the student or any of the
released parties.

IN SIGNING THE WAIVER, I ACKNOWLEDGE AND REPRESENT THAT I HAVE

read the invitation letter which is hereto attached and made an integral part of this waiver,
and the foregoing waiver.

IN WITNESS WHEREOF, I have hereunto voluntarily set my hand this

______________________ (date) in ___________________________________________,
Philippines (location).

(Signature of the Participant over Printed Name)

(Parent and/or guardian signature over printed name)

Signed in the presence of:

(Signature over printed name) (Signature over printed name)