STUDENT ORGANIZATIONS S ACTIVITIES DIVISION

SILLIMAN UNIVERSITY
3uildi n s Compcten'e, Ch arac ter c* Faith SOAD
PARTIaPANTSNANNE *.
yomcoURSE ANDYEAR LEVEL
NAME/NATURE DF ACTIVITY:
VENUE/ADDRESS: (Glve specific details)
DATE& TIME ACTIVTY STARTS
DATE &TIME ACTIVITY ENDS
ACTIVITY ORGANIZER:
CONTACT PERSON:
CONTACT NUMBER:
AS
LEGALcuSTODIANI AM ALLOwING M¥ CHILD/WARo/CHARGE TO PARTICIPATE IN THE AFOREMENTIONED STUOENT ACTIVITY WITH THE UNDERSTANDING AND
EXPECTAION THAT HE/SHE DOES NOT GET INVOLVED WITH ANY OHER ACTIVITES BEYOND WHAT HAS
THATTHEUNIVERSTY, THROUGHTHE ORGANIZERS, SHALL BE EXERCISING DUE DILIGENCE IE THE CONDUCTBEEN INTENDED BY. THE ORGANIZERS. I UNDERSTAND
OF THE ACTIVITY
ALSO:UNDERSTANDTHAT. RISKS ARE ASSOCATED WITH ANY ACTIVITY AND BY. GRANTING THIS PERMISSION, I
THEREFORE FREELY RELIEVE THE UNIVERSITY FROM LIABILITY FOR UNCIDENTS THAT ARE BEYOND THE ACKNOWLEDGE THAT SUCH RISKS DO EXIST.
CONTROL OF THE ORGANIZERS OR-BY WAY OF
EVENTS. FORTuTOUS
*
(Signature over printed riame)
(Contact No.)
PARENT/GUARDIAN
DUMAGUET CITY, NEGROS ORIENTAL 6200 PHILIPPINES +63 35 4226002 LOC. 335:
soad@su.edu.ph I www.su.edu.ph
'