Republic of the Philippines

Polytechnic University of the Philippines

College of Architecture and Fine Arts
Department of Architecture
NDC Compound, Anonas Cor. Pureza St., Sta. Mesa Manila
(02) 713-93-04

WAIVER

Cherylyn B. Concepcion Marilyn B. Concepcion

We,____________________________(student)_________________________ (parent/
guardian), hereby execute this waiver to hold the Polytechnic University of the Philippines free
from any liability for any injury / illness / loss of life or property that may be incurred/ sustained
by the student in the course of his/ her thesis consultation with their thesis adviser, AR./ENP.
ANTHONY C. YAN, at Yan and Sotto Architects and Builders office located at Unit 12, 187
Village Center, E. Rodriguez Jr. Ave., Bagumbayan, Quezon City on ___________________
provided that the same is not due to any willful criminal act or gross negligence of the thesis
adviser or any of its representatives, officers or employees.

As the parent/ guardian of the student, I hold myself responsible for any expenses that may be
incurred as a result of the student’s illness, injury, death or loss or property in the course of the
student’s thesis consultation, except as provided above. I further undertake to be responsible
for any breakage, loss of property, damage, death or injury that may be caused by the student
to any party while undergoing consultation.

We execute this waiver in accordance with our free will, realizing the benefits that the student-
trainee shall obtain from the said thesis consultation.

Cherylyn B. Concepcion Marilyn B. Concepcion

(Printed Name and Signature of (Printed Name and Signature of
Student) Parent/ Guardian)