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Internship Consent Form for CVMC

This document is a consent and waiver form for a medical internship at Cagayan Valley Medical Center Department of Pathology and Laboratories. It allows an intern named [Intern's Name] to complete a 6-month internship to fulfill their degree requirements. The parents/guardian agree to waive responsibility for any incidents that may occur during the internship, as the intern will follow the laboratory's policies and supervisor's instructions. The signatures on the form must match those on file for the intern's parents, or a legitimate guardian if a parent cannot sign. The form must be dated, signed, submitted in the first week, and notarized.

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97 views1 page

Internship Consent Form for CVMC

This document is a consent and waiver form for a medical internship at Cagayan Valley Medical Center Department of Pathology and Laboratories. It allows an intern named [Intern's Name] to complete a 6-month internship to fulfill their degree requirements. The parents/guardian agree to waive responsibility for any incidents that may occur during the internship, as the intern will follow the laboratory's policies and supervisor's instructions. The signatures on the form must match those on file for the intern's parents, or a legitimate guardian if a parent cannot sign. The form must be dated, signed, submitted in the first week, and notarized.

Uploaded by

David Dollaga
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Health
Cagayan Valley Medical Center
Regional Tertiary, Teaching and Training Hospital
Carig, Tuguegarao City, Cagayan
PHILHEALTH ACCREDITED HOSPITAL
DEPARTMENT OF PATHOLOGY AND LABORATORIES

PARENT’S/GUARDIAN’S CONSENT AND WAIVER FORM

This is to certify that I am allowing (Intern’s Name)


to go on internship for 6 months from to at Cagayan
Valley Medical Center - Department of Pathology and Laboratories in partial fulfillment of
the requirements for the degree in Bachelor of Science in Medical Technology.

It is understood that the intern will follow the policies and guidelines set by the laboratory
and abide by the rules and regulations that may be imposed by the supervisor/staff-in-charge
for his/her welfare and safety. I fully agree to waive any responsibility on the part of Cagayan
Valley Medical Center (CVMC), and the supervisor/staff–in–charge in case of any untoward
incident that may happen to my son/daughter/ during the duration of the internship.

SIGNATURE OVER PRINTED NAME OF INTERN

SIGNATURE OVER PRINTED NAME OF PARENTS/GUARDIAN

DATE & TIME:

Note:

The signature/s in this document must match the signatures of the intern’s parents on file. In
the event that a parent cannot sign the waiver form, it must be signed by the legitimate
guardian, as evidenced by the letter of guardianship on file. This document must be dated,
signed and submitted within the first week of the internship and must be notarized.

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