POLYTECHNIC UNIVERSITY OF THE PHILIPPINES College of Engineering Computer Engineering Department NDC Campus, Sta. Mesa, Manila Tel.

No. 713-59-68 WAIVER KNOW ALL MEN BY THESE PRESENTS: I, (NAME), Filipino, (AGE) years of age, with residence at (ADDRESS) and presently enrolled at these University, Sta. Mesa Manila, hereby voluntarily renounce and waived, with the consent and conformity of my parents/guardian and all claims that I may have against the said the Polytechnic University of the Philippines, and/or its officials, arising from any cause that may occur in connection with the subject (CmpE 500) Practicum II. This waiver takes effect only on the duration (April-May 2006) of the said purpose. IN WITNESS HEREOF, I hereby affix my signature this ____ day of April 2006, in the City of _____________. WITH MY CONSENT AND CONFORMITY: _______________________ Signature Over Printed Name of Parent ________________________ Signature Over Printed Name of Student

SUBSCRIBED AND SWORN TO before me this _____day of April 2006, affiant exhibited to me his/her Residence Certificate No.___________ issued at _______________ on ____________________.

Doc. No._______________ Page __________ Book No._______________ Series of _______

Notary Public

Attested By: Engr. Remedios G. Ado (Sample) Adviser