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Consentform

This document is a liability waiver for a work immersion program. It releases a cooperating company from liability if a student is injured during their work placement. Students and their parents must sign agreeing to the waiver and consenting to the student participating in the program.

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Aihce Venju Aledro
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61 views1 page

Consentform

This document is a liability waiver for a work immersion program. It releases a cooperating company from liability if a student is injured during their work placement. Students and their parents must sign agreeing to the waiver and consenting to the student participating in the program.

Uploaded by

Aihce Venju Aledro
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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ACLC College of Tacloban

Senior High School Department


Tacloban City

WORK IMMERSION AGREEMENT AND LIABILITY WAIVER


I am fully aware of the duties and responsibilities I will undertake through the Work
Immersion Program with the cooperating company through the request of
________________________________________ .

I recognize the authority of my cooperating company/agency/industry which I may be


placed and submit myself to all the Rules and Regulations that may be imposed upon myself
following the duties.

I renounce and waive any claim against the cooperating company/agency/industry and
______________________________ for any injury that I may sustain/suffer, personal/financial in
the performance of my duties/function.

Name of the Student-Trainee : ____________________________

Signature: ____________________________

Date: ____________________________

PARENTAL/GUARDIAN’S CONSENT

And I, the trainee’s parent and/or legal guardian, allow my son/daughter to undergo
Work Immersion for 80 hours starting on _____________________ until ____________________
at ___________________________________ in partial fulfilment of the requirements for Senior
High School K-12 Program.

It is understood that he/she abides 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


_________________________________ in case of any untoward incident that may happen to my
son/daughter during the duration of the WORK IMMERSION.

Name of the Parent/Guardian: ____________________________

Signature: ____________________________

Date: ____________________________

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