REPUBLIC OF THE PHILIPPINES )

CITY OF BAGUIO ) SS.

RELEASE, WAIVER & QUITCLAIM

We/I, __________________________________________________, (both) of legal age, with postal

address at ___________________________________, duly sworn in accordance with law, hereby
depose and state:

1. That we/I have given our/my (son/daughter/ward) ___________________ our/my

permission to go on field or assignments outside or around Baguio City.

2. That we/I are aware of the risks that our son/daughter may be exposed to during
these learning activities particularly, Art. II No. 7 (To assume responsibility for the care of the
students in case of illness or injury incurred during the course of affiliation) and ; Art. III No. 1
(The SECOND PARTY shall be responsible for the - Death, injury or disability of the student
nurses during the duration of their RLE, and Loss or damage to properties of the student
nurses while undergoing their RLE unless the SECOND PARTY can prove due diligence in the
performance of its obligation under the contract) of the MOA between UC and BGH. Just the
same, we allow him/her without any reservation to participate in these learning activities for
the duration of his/her course.

3. That while he is participating in the said learning activities, we hereby voluntarily

and expressly waive any or all actions, claims, or demands against University of the
Cordilleras, its trustees, officers, teachers and/or employees should our son/daughter suffer
any injury or damages which may happened beyond the control of the faculty; and we hold
harmless the said University of the Cordilleras, its trustees, officers, teachers, and/or
employees from any such action, claim or demand particularly in relation to the above-
mentioned paragraphs and to the MOA in general.

4. That similarly, we/I, _____________________________________________, hereby voluntarily

and expressly waive any or all actions, claims or demands against University of the
Cordilleras, its trustees, officers, teachers, and/or employees should I suffer any injury or
damages while I am participating in the said learning activities: and I hold harmless the said
University of the Cordilleras, its trustees, officers, teachers and/or employees from any such
action, claim or demand, provided however, that utmost care, attention and precautions are
undertaken and/or exercised by those concerned particularly in relation to the above-
mentioned paragraphs and to the MOA in general.

5. That I shall observe diligence to ensure myself and well-being.

6. That I shall comply with rules and regulations set by the University and the
organizing committee.

7. We/I declare that I have read this document and that it was fully explained to
us/me, and that we/I made this release, waiver and quitclaim willingly and voluntarily with full
knowledge and understanding of the consequences thereof.

IN WITNESS WHEREOF, we have hereunto set our hands this __th day of ___________,
_____, in Baguio City.

________________________ ________________________
Parents/Guardian Student

SUBSCRIBED AND SWORN to before me in the City of Baguio, Philippines, this __th day
of ___________, _____, by _____________________ and _______________, with ID No.
___________________________, who are the same persons who personally signed before me the
foregoing RWQ and acknowledged that they executed the same.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.