UA&P Health Forms

Email

Status

Enrolled

Alumni

Other

Student No

Have you been fully vaccinated against Covid 19? (Ikaw ba ay nakakumpleto na ng bakuna para sa Covid 19?)

Yes

Temperature ^oC

Have you worked together or stayed in the same closed environment of a confirmed COVID-19 case in the last 14 days? (Mayroon ka bang nakasama, nakatrabaho o nakasalamuha na kumpirmadong nagkaroon ng COVID-19 sa nakaraang 14 na araw?)

Yes

WAIVER & RELEASE
As part of academic and safety protocols for entry and physical access to the UA&P campus, its premises and services, I hereby agree to register via a QR Code prior to entry into the University premises and my availment of , University services on campus, including the UA&P Chaplaincy.

With such QR registration and being fully aware that UA&P is compliant with and fully implements the health protocols formulated and enforced by public authority:

I undertake to follow all precautionary measures enforced by University authority while inside the University premises;

I authorize the University to collect and process the data gathered herein for the purpose of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA 10173 (Data Privacy Act of 2012) and that I am required by RA 11469 (Bayanihan to Heal as One Act), to provide truthful information.

I hereby waive, release, and forever discharge UA&P, its administration, personnel, and agents, on behalf of myself, my heirs, and any personal representatives, from liability or accountability for any and all damages, costs, losses or consequences of whatever nature caused upon my person or property, arising from or in connection with my authorized entry and availment of University services.

I agree

I do not agree

UA&P Health Declaration for Students and Alumni UA&P Health Declaration for Students and Alumni