CBA DAYS 2024 Affidavit

Download as pdf or txt
Download as pdf or txt
You are on page 1of 2

Republic of the Philippines}

City of ________________} S.S.

AFFIDAVIT OF DECLARATION AND UNDERTAKING

I, __________________________________ [Insert full name of student],_____________[insert


year and course], a student of the University of Cebu – Banilad (“UCB”, will participate in the
following Off-Campus Activity:
Name of activity: CBA DAYS

Date of activity: MARCH 13 - 15, 2024

Time of activity: 8AM - 7PM

Location of activity: AYALA CENTRAL BLOC

Course title: BSBA

Name of teacher / professionals: MS. ELOUIS TEJADA AND SIR ERIK LEGASPI

I hereby acknowledge and agree the following:


1. ELECTIVE PARTICIPATION. I acknowledge that my participation in the Off-Campus
Activity is purely voluntary, I understand that there are alternatives to the Off-Campus
Activity as stated in the class syllabus.

2. RULES AND REQUIREMENTS. I agree to abide by all the applicable rules and
requirements of UCB and the site of the Off-Campus Activity.

I likewise commit to abide by the health protocols that may issue by UCB, the site of the
Off-Campus Activity, and the national and local governments to prevent the transmission
of SARS-CoV-2/COVID-19.

3. MEDICAL. I am aware of all my pertinent medical needs, and I am unaware of my health


related reasons or problems which preclude or restrict my participation in the Off-Campus
Activity.

4. EXPOSURE TO OR CONTRACTING SARS-CoV-2/COVID. I understand that


SARS-CoV-2/COVID-19 (and its various strains) is a highly contagious virus/disease and
contracting it may result in mild to severe illness, serious health consequences, or even
death. Despite this, I have willfully and voluntarily decided to participate in the cannot
guarantee that I will be spared of the potential consequences of exposure or infection. I
knowingly and voluntarily assume all such risks of exposure, infection, and their
consequences, and I assume full responsibility for the same.
5. INDEMNITY. I, on behalf of myself, my personal representatives, heirs, executors,
administrators, agents, and assigns, is hereby undertake forever discharge UCB, including
its officers, trustees, agents, and/or employees, from any and all claims, lawsuits,
demands, costs, expenses, damages, or liabilities due to illness, injuries, losses, or death
arising wholly, partially, directly, or indirectly from my participation in the Off-Campus
Activity.

I hereby sign this Affidavit of Declaration and Undertaking freely and voluntarily without any
inducement and wish full intention to be bound by its terms.

IN WITHNESS WHEREOF, I set my hand this _____________ (Date signed) at ___________


(Place signed), Philippines.

_____________________________________ ____________________________________
Parent’s Signature over Printed Name Student’s Signature over Printed Name Valid
Government ID No.________________ School ID No.________________________
(Please attach photocopy of valid government ID) (Please attach photocopy of School ID)

Noted by:
______________________________________________________
Adviser’s/Dean’s/Department Head’s Signature over Printed Name
Valid Government ID No.
(Please attached photocopy of valid government ID)

SUBSCRIBED AND SWORN to before me on the date and place above written, affiants
exhibiting to me their competent evidence of identity.

Doc. No. _________:


Page No. _________:
Book No. _________:
Series of _________:

NOTE: Reproduce at least (4) copies of this Affidavit and affix the original signature on each copy.

You might also like