Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna
WAIVER
Date:_______________
To whom it may concern:
As the parent/guardian of ___________________________________________________________
(Name of Student)
Department/Unit Sponsoring Activity: Office of the Sports and Cultural Affairs
Nature of Activity : Color FunRun 2024
Date of Activity : May 5 2024
Place of Activity : Sampaloc Lake San Pablo City
Time of Activity : 5am onwards
Faculty/Adviser/Staff-in-Charge:_______________________________________________________
Together with my child, I know that Laguna State Polytechnic University and its officers, faculty, and staffs are
expected to exercise the legal diligence required for the safety and well-being of my child for the duration and the place,
date and time of the activity as stated.
This legal diligence would include oral or written instructions whether given before or during the activity, that if
followed, would ensure the safety of my child.
If my child disregards or fails to follow those instructions or should act on his/her own, I together with my child,
shall have no claims against the school, its officers, faculty, adviser, staff-in-charge should any damage be caused or liability
be incurred to property or person.
Respectfully yours,
____________________________________ Contact number:_________________
Signature over Printed Name
of Parent/Guardian
____________________________________ Contact number:_________________
Signature over Printed Name
of Student
LSPU-OSAS-SF-010Rev.010 August 2016

Student
Copy Republic of the Philippines
Laguna State Polytechnic University
Province of Laguna
WAIVER
Date:_______________
To whom it may concern:
As the parent/guardian of __________________________________________________________
(Name of Student)
Department/Unit Sponsoring Activity:Office of the Sports and Cultural Affairs
Nature of Activity : Color FunRun 2024
Date of Activity : May 5 2024
Place of Activity : Sampaloc Lake San Pablo City
Time of Activity : 5am onwards
Faculty/Adviser/Staff-in-Charge:_______________________________________________________
Together with my child, I know that Laguna State Polytechnic University and its officers, faculty, and staffs are
expected to exercise the legal diligence required for the safety and well-being of my child for the duration and the
place,date and time of the activity as stated.
This legal diligence would include oral or written instructions whether given before or during the activity, that if
followed, would ensure the safety of my child.
If my child disregards or fails to follow those instructions or should act on his/her own, I together with my child,
shall have no claims against the school, its officers, faculty, adviser, staff-in-charge should any damage be caused or liability
be incurred to property or person.

Respectfully yours,
____________________________________ Co
number:_________________
Signature over Printed Name
of Parent/Guardian
LSPU-OSAS-SF-010Rev.010 August 2016
____________________________________ Co