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Internship Liability Waiver Form

This document is a waiver form for a student completing an internship in industrial engineering. The parent/guardian signs to acknowledge that they are responsible for any injuries sustained by their son/daughter during the internship. The internship organization is not liable for injuries caused by the student's work or decisions. The waiver also releases the Polytechnic University of the Philippines from any liability arising from injuries during the internship. The parent consents to the student's internship schedule and signs the waiver along with the student.

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Jerome Dalisay
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145 views1 page

Internship Liability Waiver Form

This document is a waiver form for a student completing an internship in industrial engineering. The parent/guardian signs to acknowledge that they are responsible for any injuries sustained by their son/daughter during the internship. The internship organization is not liable for injuries caused by the student's work or decisions. The waiver also releases the Polytechnic University of the Philippines from any liability arising from injuries during the internship. The parent consents to the student's internship schedule and signs the waiver along with the student.

Uploaded by

Jerome Dalisay
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

Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES


OFFICE OF THE VICE PRESIDENT FOR BRANCHES AND CAMPUSES
BATAAN BRANCH

WAIVER
KNOW ALL MEN BY THESE PRESENT:

I, ________________________________, parent/ guardian of ______________________ who is


willing to do an internship with _____________________________________________ in the area of
Industrial Engineering, understand that I am responsible for any injuries that my
son/daughter might sustain during his/her internship period on the onset of the prejudged
knowledge of his/her work and decisions. The
____________________________________________________ is NOT RESPONSIBLE OR LIABLE for
any injuries my son/daughter may sustain during his/her internship based from the caused
mentioned above.

As my son/daughter will receive clear benefit from this internship, I am allowing my


son/daughter to report for internship on the following schedules

DAY TIME

__________________________ __________________________

__________________________ __________________________

__________________________ __________________________

__________________________ __________________________

__________________________ __________________________

In consideration of the Academe’s direction for such internship, I hereby release a


covenant not to sue, waive and discharge the Polytechnic University of the Philippines, their
officers, faculty or employees from any claims of liability arising out of any loss, damage, or
injury including death, that may be sustained by one while participating in the internship, or
while in, on, or upon the premises when the internship is being conducted.

WITH MY CONSENT AND CONFORMITY:

Parent/Guardian’s Signature over Printed Name Student’s Signature over Printed Name

ID No. _________________________
Issued at_________________________
Issued on ________________________

SUBCRIBE AND SWORN TO before me this _____________________, affiant exhibited to me


his/her Residence Certificate No. issued at ______________________ on _________________.

Doc No. ____________ Page No. _____ Notary Public


Book No. ___________ Series 2014

Attested by:

Ruevan Evangelista Alboro


Practicum Instructor

Leonila J. Generales
Director

Brgy. Malaya, Freeport Area of Bataan(FAB), Mariveles, Bataan


Phone No. (047)9357019 (047)9357071
THE COUNTRY’S 1ST POLYTECHNICU”

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