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This document is a waiver form for a student undergoing training or field exposure as part of their course requirements at Bataan Peninsula State University. The student affirms that the company they will do their training at will not be responsible for any accidents during the training period, as the student is insured by the University's accident and health protection program. The student and their parent/guardian sign to agree to the terms of the waiver and that the training will take place between specified dates.

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Emz Dueñas Tungol
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104 views1 page

Sample

This document is a waiver form for a student undergoing training or field exposure as part of their course requirements at Bataan Peninsula State University. The student affirms that the company they will do their training at will not be responsible for any accidents during the training period, as the student is insured by the University's accident and health protection program. The student and their parent/guardian sign to agree to the terms of the waiver and that the training will take place between specified dates.

Uploaded by

Emz Dueñas Tungol
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

BATAAN PENINSULA STATE UNIVERSITY

City of Balanga, 2100 Bataan


Republic of the Philippines

____________________
Date:

WAIVER:
TO WHOM IT MAY CONCERN:

In view of my ___________________________________________________________
(Nature of Training or Field of Exposure)
at __________________________________________________________________________,
(Name & Address of Company)
as partial fulfillment of the requirements of my course ________________________________.
(Course & Major)

I, ___________________________________________________ a bonafide student of


(Name of Student)
Bataan Peninsula State University Main Campus of the College of Engineering and Architecture,
AY ____________________ hereby affirm that the company herein stated is in no
(Academic Year)
way responsible nor shall pay any compensation for any untoward incident that may happen
during my training since I am insured under the Group Accident and Health Protection Program
(GAHPP) of the University.

I also certify that in my own freewill, I signify my intent to undergo this training/ exposure
from ___________________________ to ________________________.
(Start) (End)

________________________________________ _________________________________
(Signature of Parent/ Guardian over printed name) (Signature of student over printed name)

________________________________________ _________________________________
(Date) (Date)

SIGNED IN THE PRESENCE OF:

ENGR. JELENNY P. NAVARRO, MEM


OJT Coordinator, BSCE

______________________
(Date)

SUBSCRIBED AND SWORN TO before me this ____________________________ day of


________________________ 2020 at ________________________________________.

NOMER N.VARUA, MAEd


Chairperson, Student Affairs and Services

Our Vision Our Mission


To develop competitive graduates and empowered community members by
A leading university in the Philippines recognized for its providing relevant, innovative and transformative knowledge, research, extension
proactive contribution to Sustainable Development through and production programs and services through progressive enhancement of its
equitable and inclusive programs and services by 2030 human resource capabilities and institutional mechanisms

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