OFFICE OF STUDENT ACTIVITIES by uNq5Ch4a

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									                           LOYOLA SCHOOLS – OFFICE OF STUDENT ACTIVITIES
                                   ATENEO DE MANILA UNIVERSITY

                                                       Waiver Form
                                             For Students Above 18 years of Age

Name of Student Group                                                        Date & Time

Name of Activity                                                             Venue

Name of Project Head                                                         Contact No.

Name of Adult Supervisor                                                     Contact No.

Name of Moderator                                                            Signature

     We, the undersigned, cognizant of the risks and benefits involved in this activity held off-campus, take upon
ourselves the responsibility of safeguarding all those involved. And having obtained the necessary permission from our
parents or guardian and the Ateneo de Manila University through the Loyola Schools - Office of Student Activities, we
shall be accountable for any untoward incident that may take place.

Participants: (Separate sheets may be used for additional names)

                Name in Print                                      Course and Year               Signature
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NOTE:
This document assumes that the organization already informed the Adult Supervisor of his/her duties and that the
moderator affixed his/her signature based on full knowledge of the activity and its arrangements.


                                    – Leadership Formation through Organization Development –
                                                                                                LS-OSA waiver 18a 70909
                                                                                                            Page 1 of 1

								
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