WAIVER

KNOW ALL MEN BY THESE PRESENTS:

I, KATELEEN J. MANGIRAL, Filipino, 17 years of age, with residence at #292

Talaga, Capas, Tarlac, hereby voluntary renounce and waived, with the consent and
conformity of my parents/guardian and all claims that I have against the said the
College of Nursing of Tarlac State University, and/or its officials, arising from any cause
that may occur in connection with the subject Nursing Community Service.

IN WITNESS WHEREOF, I hereby affixed my signature this _____ day of May

2018, in the City of Tarlac.

WITH MY CONSENT AND CONFORMITY:

IMELDA J. MANGIRAL KATELEEN J. MANGIRAL

Parent/Guardian Student

SUBSCRIBED AND SWORN to before me this _____ day of May 2018, in the
City of Tarlac, Philippines.

Doc. No. _____;

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