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Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES


Office of the Vice President for Branches and
Campuses
TAGUIG BRANCH
FIELD TRIPS AND SEMINARS WAIVER OF LIABILITIES

I, ______________________________ , BSECE V-1 of legal age, and a resident of


____________________________________________________________ , will be joining a field trip which is a
curriculum requirement for our subject ECEN 3431: ECE Field Trips and Seminars. This endeavor will convene at
Baguio City from November 26 to November 29 headed by our professor Engr. Reginald Raquiza.

I am aware that we are going to visit different companies in Baguio City in order for us to be oriented on the
applications of the theories and concepts we have gained inside the classroom.

In consideration, therefore, I hereby freely and voluntarily assume the following duties:

1. That, I recognize the authority of my cooperating leaders / facilitators / officers and submit myself to all the
rules and regulations that may be imposed upon me in connection with this event,
2. That, I, myself will be the one to shoulder all my expenses including food, transportation and
lodging/amenities, and –
3. That, I renounce and waive my claim against the Polytechnic University of the Philippines (Taguig Branch)
and its staff for any injury that I may sustain in such circumstances that is beyond human control, or loss
that I may suffer, personal or pecuniary, in the performance of my duties or functions while under this
activity.

Signed this _____ day of September 2018 at Polytechnic University of the Philippines, Taguig Campus.

_________________________
Name of Student

Witness:

ENGR. REGINALD RAQUIZA


Subject Adviser

PARENTAL CONSENT FORM

I, ______________________________ , of legal age and a resident of


____________________________________________________________ , hereby authorize the Polytechnic
University of the Philippines- Taguig Campus, to send ______________________________ for the Field Trips
and Seminars..

I hereby waive/renounce the right to any complaint for compensation or course of action against PUP
Taguig in any case of any accident/injury in the course of the Field Trips and Seminars..

In view of the foregoing, I hereby affixed my signature below this _____ day of September 2018 at Taguig
City.

______________________________
Affiant

JURAT

SUBCRIBED AND SWORN to before me this _____ day of September 2018, affiant exhibiting to me his/her
government issued Identification Card No. _____________________ issued by________________________ with
expiry date on _________________. (Name of Government Agency)

WITNESS MY HAND AND SEAL on the day first above written.

NOTARY PUBLIC
Doc No.______;
Page No._____;
Book No._____;
Series of 2018

Gen. Santos Ave. Lower Bicutan, Taguig City 1772; (Direct Line) 837-5858 to 60; (Telefax) 837-5859; website:
www.pup.edu.ph e-mail: taguig@pup.edu.ph

“THE COUNTRY’S 1st POLYTECHNICU”


Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
Office of the Vice President for Branches and
Campuses
TAGUIG BRANCH

Gen. Santos Ave. Lower Bicutan, Taguig City 1772; (Direct Line) 837-5858 to 60; (Telefax) 837-5859; website:
www.pup.edu.ph e-mail: taguig@pup.edu.ph

“THE COUNTRY’S 1st POLYTECHNICU”