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    Consent of Parent/Guardian Certification of Waiver: University of The Philippines Los Baños

    Uploaded by

    Jeanie Junio
    This document contains a consent form signed by a parent allowing their son/daughter to complete an internship with a communication organization from June 17 to July 22, 2015. It specifies that the student will abide by the host organization's rules and the university's code of conduct. The parent agrees to waive responsibility for any incidents during the internship and cover personal expenses. The document also includes a pledge signed by the student agreeing to follow the host organization's guidelines and supervision during the internship period.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Consent of Parent/Guardian Certification of Waiver: University of The Philippines Los Baños

    Uploaded by

    Jeanie Junio
    30 views2 pages
    This document contains a consent form signed by a parent allowing their son/daughter to complete an internship with a communication organization from June 17 to July 22, 2015. It specifies that the student will abide by the host organization's rules and the university's code of conduct. The parent agrees to waive responsibility for any incidents during the internship and cover personal expenses. The document also includes a pledge signed by the student agreeing to follow the host organization's guidelines and supervision during the internship period.

    Original Description:

    Sample document waiver

    Original Title

    Certificate of Waiver DEVC190-MY2015

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    © © All Rights Reserved

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    This document contains a consent form signed by a parent allowing their son/daughter to complete an internship with a communication organization from June 17 to July 22, 2015. It specifies that the student will abide by the host organization's rules and the university's code of conduct. The parent agrees to waive responsibility for any incidents during the internship and cover personal expenses. The document also includes a pledge signed by the student agreeing to follow the host organization's guidelines and supervision during the internship period.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views2 pages

    Consent of Parent/Guardian Certification of Waiver: University of The Philippines Los Baños

    Uploaded by

    Jeanie Junio
    This document contains a consent form signed by a parent allowing their son/daughter to complete an internship with a communication organization from June 17 to July 22, 2015. It specifies that the student will abide by the host organization's rules and the university's code of conduct. The parent agrees to waive responsibility for any incidents during the internship and cover personal expenses. The document also includes a pledge signed by the student agreeing to follow the host organization's guidelines and supervision during the internship period.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    UNIVERSITY of the PHILIPPINES LOS BAOS

    College, Laguna 4031, Philippines


    Tels.: (63) (049) 5362511 (63)(049) 5362433 (63)(049) 5363356
    Fax: (63) (049) 5362429
    UPLB-CDC Form No. 1A
    February 2013

    CONSENT OF PARENT/GUARDIAN
    on DEVC 190 (Communication Internship)
    and

    CERTIFICATION OF WAIVER
    I _________________________________, of legal age, residing in ____________________
    _____________________, and parent/guardian of _________________________________
    (Student Number: ___________ ), student of the College of Development Communication,
    University of the Philippines Los Baos, Laguna, do hereby authorize him/her to undertake
    his/her internship program at ____________________________________, with address at
    _____________________________________________ from 17 June 2015 to 22 July 2015.
    It is understood that my son/daughter shall abide by the Rules and Regulations on Student
    Conduct and Discipline of UPLB, as well as the policies and on-the-job training guidelines of
    the organization/agency he/she is assigned to.
    It is further understood that I fully agree to waive any responsibility on the part of the
    University in case any untoward incident happens to my son/daughter during the internship
    period. I hereby further agree to shoulder personal and incidental expenses of my
    son/daughter in connection with this internship program.
    In witness whereof, I have signed this document this ______ day of April, 2013 _______ at
    __________________________.
    ______________________________________
    Signature over printed name of Parent/Guardian
    Witness/es:
    __________________________

    __________________________

    Subscribed and sworn to me this _____ day of June 2015 in the Municipality of
    _________________, in the Province of ____________________, the affiant exhibited to me
    his/her Res. Cert. No. or valid government-issued ID _______________________________,
    issued on ______________________ at ___________________________.
    ____________________________
    Notary Public
    Doc. No.
    Pages No.
    Book No.
    Series of

    ________
    ________
    ________
    ________

    Until
    TIN
    PTR

    _____________
    _____________
    _____________

    UNIVERSITY of the PHILIPPINES LOS BAOS


    College, Laguna 4031, Philippines
    Tels.: (63) (049) 5362511 (63)(049) 5362433 (63)(049) 5363356
    Fax: (63) (049) 5362429
    UPLB-CDC Form No. 1B
    February 2013

    _____________________
    Date

    STUDENTS PLEDGE

    I ______________________________________, a student of the College of Development


    Communication, University of the Philippines Los Baos (UPLB), do hereby agree to abide
    by the Rules and Regulations on Student Conduct and Discipline of UPLB, as well as the
    policies and on-the-job training guidelines of ______________________________________
    (name of organization/ agency). It is further understood that while on this internship program,
    I shall be under the direct supervision of the organizations/agencys internship coordinator.
    ____________________________________
    Students Signature over Printed Name
    ____________________________________
    Student Number

    Medical/Insurance Policy Name and Number: (Please attach a photocopy of the policy)
    Company/Agency/Provider

    ________________________________________

    Policy Number

    ________________________________________

    Expires: ________________

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