Waiver

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MEMORANDUM OF AGREEMENT

(Activity conducted Outside Region IV-A)

KNOW ALL MEN BY THESE PRESENTS:

This Agreement made and entered into by and among:

SOUTHERN LUZON STATE UNIVERSITY, a state university, organized, and existing under
the laws of the Republic of the Philippines, with principal office address at Quezon Ave., Brgy.
Kulapi, Lucban, Quezon, through its University President DR. MILO O. PLACINO, represented by its
Vice-President for Academic Affairs, Dr. MARISSA C. ESPERAL, hereinafter to as the “FIRST
PARTY”

- and -

__________________________________________________, of legal age, Filipino, and a resident of


________________________________________________, and herein referred to as the “SECOND PARTY”.

WITNESSETH:

WHEREAS, the FIRST PARTY is mandated to provide advanced education in different areas
of professional and technological instruction and to provide progressive leadership in its areas of
specialization;

WHEREAS, the FIRST PARTY, being a state university is regulated by the Commission on
Higher Education (CHED) and is bound to adhere to the policies and guidelines prescribed by the
latter in carrying out its mandates and functions;

WHEREAS, the FIRST PARTY received an invitation from the


___________________________________________________________________________________________ to participate in the
_______________________________________________________ to be held at ________________________________________ on
___________________________________;

WHEREAS, the objective of the said activity/event is to enhance and build the youngster’s
self-discipline and develop potentials in the field of __________________________________________________;

WHEREAS, the SECOND PARTY exercises parental authority over the student/participant
and allowed the latter to participate in the aforesaid activity/event.

NOW, THEREFORE, for and in consideration of the foregoing premises, the parties hereto
agree to enter into this Agreement under the following terms and conditions:

I. FIRST PARTY shall:

1. Provide a sufficient number of faculty members to accompany the “students” at the


venue and at the designated accommodation for said activity/event;

2. Provide information to students and parents pertaining to the risks associated in


involvement in the said activity/event;

3. Be responsible for the safety and assistance of the “students” who will participate in the
aforesaid activity/event; and

4. Be hold absolutely free and harmless from any and future liabilities arising from loss,
damage, or injury that may be sustained by the “student” resulting from their
involvement in the said activity/event.

II. SECOND PARTY shall:

1. Allow __________________________________________________ (name of student) to participate in the


aforesaid activity/event to be held on _______________________________________________________ at
___________________________________;
2. Provide moral and financial support necessary for the student’s participation in the said
activity/event;

3. Understand that the attendance of the “student” in the said activity/event may expose
the latter in a variety of foreseen and unforeseen hazards and risks which includes
personal injury;

4. Whenever practicable, accompany the aforesaid “student” at the venue of the


activity/event and at their accommodation during the duration of the activity/event;
and

5. Hold the FIRST PARTY, its officers, faculty, and employees absolutely free and harmless
from any and future liability arising from loss, damage, or injury that may be sustained
by the aforesaid “student” resulting from the involvement in the said activity/event.

IN WITNESS WHEREOF, the parties hereto have set their hands and affixed their signatures
this _________________________ at _________________________.

SOUTHERN LUZON STATE UNIVERSITY


FIRST PARTY by:

MILO O. PLACINO, Ph.D.


University President

REPRESENTED by: SECOND PARTY by:

Dr. MARISSA C. ESPERAL _____________________________________________


Vice-President for Academic Affairs Signature over Printed Name of Parent

SIGNED IN THE PRESENCE OF:

EDSEL P. PAROAN _____________________________________________


Dean, Student Affairs and Services Dean, College of __________________________________

ACKNOWLEDGMENT

Republic of the Philippines )


___________________________________ ) S.S
___________________________________ )

BEFORE ME, the undersigned Notary Public, for and in the Province of Quezon, personally
appeared Dr. MARISSA C. ESPERAL with Identification Card No. ______________________________ and
_____________________________________________ with Identification Card No. ______________________________ both
known to me and known to be the same persons who executed the foregoing Memorandum of
Agreement consisting of three (3) pages including the page on which this Acknowledgment is
written, duly signed by them, and by their instrument witnesses and they acknowledged the same
to be their own, free and voluntary act and deed.

WITNESS MY HAND AND SEAL on this _______________________ at _______________________.

Doc. No.: _____;


Page No.: _____;
Book No.: _____;
Series of 2018.

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