Waiver (Long Bond Paper)

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New Era University

No. 9 Central Ave., New Era Quezon City


Department of Computer Science
Date: _________________
________________________________________
________________________________________
Dear Sir / Maam:
The undersigned wishes to inform you that your child / ward _____________________________________ together with his
/ her classmates will undertake an off-campus activity on _________________________ at _________________________.
Date/s

Location/Time

The purpose of this activity is (indicate expenses/materials needed):


__________________________________________________________________________________________________
_________________________________________________________________________________________________.
In view of this, we wish to obtain your consent for him / her to join / attend this activity by signing the waiver below.
Thank You.
Truly Yours,

If Dorm resident:

_______________________
Teacher/Instructor

________________________
SAO Director
CONSENT

We / I, ____________________________________________, parents / guardian of the Elem. / High School /


College student _______________________________________, section __________________________________.
Name of Student

We / I hereby affix our / my signature as a proof of our / my consent to our / my childs joining the
_____________________________________________________ in _______________________________________.
activity

location

We / I hereby hold free and harmless New Era University, ____________________________ and any of its
Department / Branch

officers, teachers, and staff in the event of any accident, injury or sickness that may befall our / my child in the course of this
activity knowing that the school shall and will exercise extra ordinary diligence.
Signed this _____ of ______________, ________ , in _________________________________________________.
Day

Month

Year

________________________________

Place

_________________________________

Relation

Signature over printed name

(UMO Copy)

CONSENT
We / I, ____________________________________________, parents / guardian of the Elem. / High School /
College student _______________________________________, section __________________________________.
Name of Student

We / I hereby affix our / my signature as a proof of our / my consent to our / my childs joining the
_____________________________________________________ in _______________________________________.
activity

location

We / I hereby hold free and harmless New Era University, ____________________________ and any of its
Department / Branch

officers, teachers, and staff in the event of any accident, injury or sickness that may befall our / my child in the course of this
activity knowing that the school shall and will exercise extra ordinary diligence.
Signed this _____ of ______________, ________, in _________________________________________________.
Day

Month

________________________________

Relation

Year

Place

_________________________________

Signature over printed name

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