PAMANTASAN NG LUNGSOD NG MAYNILA
(University of the City of Manila)
Intramuros, Manila
Office of Student Development and Services
WAIVER FORM A
Name of Approved
Activity
Date and Time
Venue/s
Name of Adviser
This is certify that I allow my son/daughter/ward, ,a
student from the , with student
number to join the on at
.
I voluntarily and knowingly waive all rights and causes of actions against Pamantasan ng Lungsod ng Maynila, its
faculty members, employees, officials and administrators, except for liabilities arising from injuries and damages
caused by gross negligence on the part of the university.
I further certify that I allow my son/daughter/ward to contribute for the said undertaking.
In case of emergency, please contact:
Signature over Printed Name
Relationship to the Student
Date
Attachments
Copy of signatory’s identification card with signature
Copy of affidavit of guardianship (for guardians)
To be accomplished by Adviser
Received by
Date and time received