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    Waiver Form B: (For Professional and Graduate Students)

    Uploaded by

    John Bryan Jamison
    This waiver form summarizes the details of a student participating in an extracurricular activity. It states that the student, John Herbie Cipriano Novero, will voluntarily participate in Palarong Medisina 2018: SIKLAB on February 25 and March 4, 2018 from 7:00 AM to 7:00 PM at the Adventist University of the Philippines in Silang, Cavite. The form waives the student's rights to take action against Pamantasan ng Lungsod ng Maynila for any liabilities, except those from gross negligence. It also provides contact information for emergencies.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Waiver Form B: (For Professional and Graduate Students)

    Uploaded by

    John Bryan Jamison
    70 views1 page
    This waiver form summarizes the details of a student participating in an extracurricular activity. It states that the student, John Herbie Cipriano Novero, will voluntarily participate in Palarong Medisina 2018: SIKLAB on February 25 and March 4, 2018 from 7:00 AM to 7:00 PM at the Adventist University of the Philippines in Silang, Cavite. The form waives the student's rights to take action against Pamantasan ng Lungsod ng Maynila for any liabilities, except those from gross negligence. It also provides contact information for emergencies.

    Original Description:

    PLM waiver

    Original Title

    PLM Waiver 1 Flattened (1)

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    This waiver form summarizes the details of a student participating in an extracurricular activity. It states that the student, John Herbie Cipriano Novero, will voluntarily participate in Palarong Medisina 2018: SIKLAB on February 25 and March 4, 2018 from 7:00 AM to 7:00 PM at the Adventist University of the Philippines in Silang, Cavite. The form waives the student's rights to take action against Pamantasan ng Lungsod ng Maynila for any liabilities, except those from gross negligence. It also provides contact information for emergencies.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    70 views1 page

    Waiver Form B: (For Professional and Graduate Students)

    Uploaded by

    John Bryan Jamison
    This waiver form summarizes the details of a student participating in an extracurricular activity. It states that the student, John Herbie Cipriano Novero, will voluntarily participate in Palarong Medisina 2018: SIKLAB on February 25 and March 4, 2018 from 7:00 AM to 7:00 PM at the Adventist University of the Philippines in Silang, Cavite. The form waives the student's rights to take action against Pamantasan ng Lungsod ng Maynila for any liabilities, except those from gross negligence. It also provides contact information for emergencies.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    WAIVER FORM B

    (for Professional and Graduate Students)

    Name of Approved Activity: PALARONG MEDISINA 2018: SIKLAB


    Date and Time: FEBRUARY 25 AND MARCH 4, 2018 ; 7:00 AM – 7:00 PM
    Venue/s: ADVENTIST UNIVERSITY OF THE PHILIPPINES – SILANG, CAVITE
    Name of Adviser:

    This is to certify that I, John Herbie Cipriano Novero , a 1st Year Medicine student from the College of Medicine
    with student number 2017-70119 am voluntarily participating in the Palarong Medisina 2018: SIKLAB, on
    February 25 and March 4, 2018 from 7:00 AM to 7:00 PM at the Adventist University of the Philippines, Silang,
    Cavite.

    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 am voluntarily contributing N/A for the said undertaking.

    In case of emergency, please contact:

    Name of Contact Person: Hermingildo P. Novero


    Relationship to Student: Father_____________
    Contact Number/s: 09196304912________

    ____________________________
    Signature over Printed Name
    Date:______________

    Attachments:
     Copy of student’s PLM identification card

    To be accomplished by Adviser:
    Received by:

    Date and Time Received:

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