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Petroleum Engineering Department: WWW - Batstate-U.edu - PH

This document is a waiver form for a fieldwork activity by the Petroleum Engineering Department of Batangas State University. A student is waiving any claims against the school for injuries during a fieldwork activity in Brgy. Malabrigo, Lobo, Batangas on July 18, 2015. The student also agrees to be responsible for any damages to property or injuries to others that may occur during the activity. The waiver requires signatures from the student, parent or guardian, instructor, department chair, and dean.

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Rhay-Anne Lentejas
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31 views2 pages

Petroleum Engineering Department: WWW - Batstate-U.edu - PH

This document is a waiver form for a fieldwork activity by the Petroleum Engineering Department of Batangas State University. A student is waiving any claims against the school for injuries during a fieldwork activity in Brgy. Malabrigo, Lobo, Batangas on July 18, 2015. The student also agrees to be responsible for any damages to property or injuries to others that may occur during the activity. The waiver requires signatures from the student, parent or guardian, instructor, department chair, and dean.

Uploaded by

Rhay-Anne Lentejas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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BATANGAS STATE UNIVERSITY

College of Engineering, Architecture and Fine Arts


Gov. Pablo Borbon Campus II, Alangilan, Batangas City, Philippines 4200
www.batstate-u.edu.ph
Telefax: (043) 300-4404 locs. 106-118

Petroleum Engineering Department


WAIVER
I, _______________________________, a bonafide Petroleum Engineering Student of Batangas State University with
student number _____________ do hereby voluntarily join the Fieldwork activity in Brgy. Malabrigo, Lobo, Batangas
on July 18, 2015 under the following terms and conditions:
1. That I shall renounce and waive any claim against the school/establishment for any injury or accident that I may
suffer; and
2. That I shall be answerable for any liabilities for damages to property or injury to third person/s which may be
caused by me intentionally or inadvertently while in the course of this activity.
____________________________________
Students Signature over Printed Name

____________________________________
Parents/Guardians Signature over
Printed Name&Contact No.

ENGR. MARVIN A. ATIENZA


Instructor, PetE 302-Physical Geology

ENGR. ROCEL D. GUALBERTO


Chairman, ME/PETE Department
DR. ELISA D. GUTIERREZ
Dean, CEAFA

BATANGAS STATE UNIVERSITY


College of Engineering, Architecture and Fine Arts
Gov. Pablo Borbon Campus II, Alangilan, Batangas City, Philippines 4200
www.batstate-u.edu.ph
Telefax: (043) 300-4404 locs. 106-118

Petroleum Engineering Department


WAIVER
I, _______________________________, a bonafide Petroleum Engineering Student of Batangas State University with
student number _____________ do hereby voluntarily join the Fieldwork activity in Brgy. Malabrigo, Lobo, Batangas
on July 18, 2015 under the following terms and conditions:
1. That I shall renounce and waive any claim against the school/establishment for any injury or accident that I may
suffer; and
2. That I shall be answerable for any liabilities for damages to property or injury to third person/s which may be
caused by me intentionally or inadvertently while in the course of this activity.
____________________________________
Students Signature over Printed Name

____________________________________
Parents/Guardians Signature over
Printed Name&Contact No.

ENGR. MARVIN A. ATIENZA


Instructor, PetE 302-Physical Geology

ENGR. ROCEL D. GUALBERTO


Chairman, ME/PETE Department
DR. ELISA D. GUTIERREZ
Dean, CEAFA

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