STUDENTS WAIVER

____________________________________________________________________________________________
Family Name
Given Name
Middle Name
____________________________________________________________________________________________
No. Streets
Address
Contact Number
Date of Birth:
Month

Day

Year

Age

Sex

Civil Status

In consideration of the acceptance of my entry, myself, my heirs, executors, administration and assigns, do
hereby release and discharge the respective school and official, teacher, pool management, the Commission on
Higher Education, and other concerned institutions, private or government, and other parties, individual or group,
from all claims and damages, demands or actions whatsoever in any manner arising from or growing out or may
participate in, or while traveling to and from. I further agree that will not represent or join any other
university/college in any competition outside the PASUC NSO, until such time that the organizers permit me to do
so. I further attest and verify that I have full knowledge of the risks involved and with my parent-consent to
participate and that I am physically fit and sufficiently participate in this event. I further give my consent to the use
of my name and photograph and/or videotape for publicity purposes.
This is to certify that I have knowledge of and permission for my son/daughter to join and participate in the
swimming lessons and I concur and agree with the rules, policies and regulations being implemented by the
teacher/university/pool administrator.
_________________________________
STUDENTS SIGNATURE
(Signature over Printed Name)

____________________________________
PARENTS/GUARDIANS SIGNATURE
(Signature over Printed Name)

STUDENTS WAIVER
____________________________________________________________________________________________
Family Name
Given Name
Middle Name
____________________________________________________________________________________________
No. Streets
Address
Contact Number
Date of Birth:
Month

Day

Year

Age

Sex

Civil Status

In consideration of the acceptance of my entry, myself, my heirs, executors, administration and assigns, do
hereby release and discharge the respective school and official, teacher, pool management, the Commission on
Higher Education, and other concerned institutions, private or government, and other parties, individual or group,
from all claims and damages, demands or actions whatsoever in any manner arising from or growing out or may
participate in, or while traveling to and from. I further agree that will not represent or join any other
university/college in any competition outside the PASUC NSO, until such time that the organizers permit me to do
so. I further attest and verify that I have full knowledge of the risks involved and with my parent-consent to
participate and that I am physically fit and sufficiently participate in this event. I further give my consent to the use
of my name and photograph and/or videotape for publicity purposes.
This is to certify that I have knowledge of and permission for my son/daughter to join and participate in the
swimming lessons and I concur and agree with the rules, policies and regulations being implemented by the
teacher/university/pool administrator.
_________________________________
STUDENTS SIGNATURE
(Signature over Printed Name)

____________________________________
PARENTS/GUARDIANS SIGNATURE
(Signature over Printed Name)