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Consent-form-Work Immersion Program

1) This document is a parent/guardian consent form for students participating in the Work Immersion Program at San Bartolome Integrated High School. 2) It requires signatures from the parent/guardian to give permission for their child to participate, to authorize emergency medical treatment if needed, and to waive liability for any injuries that may occur during the program. 3) The final section is for notarizing the parent/guardian's signatures.

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Loren Danielle
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181 views2 pages

Consent-form-Work Immersion Program

1) This document is a parent/guardian consent form for students participating in the Work Immersion Program at San Bartolome Integrated High School. 2) It requires signatures from the parent/guardian to give permission for their child to participate, to authorize emergency medical treatment if needed, and to waive liability for any injuries that may occur during the program. 3) The final section is for notarizing the parent/guardian's signatures.

Uploaded by

Loren Danielle
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

Department of Education
Region IVA – CALABARZON
Schools Division of San Pablo City
San Bartolome Integrated High School
Brgy. San Bartolome, San Pablo City, Laguna

Parent/Guardian Consent Form—Work Immersion Program


Please complete all blanks and sign in three places.

Student’s Name:
(Signature above printed name)

Part I: Permission to Participate

I have understood the information concerning the work immersion programs and give my son/daughter,
___________________________ permission to participate in the programs. I realize that each student must
provide his/her own transportation to and from the workplace site. I also understand that my son/ daughter must
meet the application requirements to be accepted into the program.

Signature of Parent/Guardian Date

Part II: Emergency Authorization

In the event that I cannot be reached in an emergency, I give permission to the teacher in-charge to secure proper
treatment for my son/daughter.

Signature of Parent/Guardian Date

In case of emergency, contact: ___________________________________

Telephone/Cellphone Number:

Part III: Liability

I hereby agree to waive and release any and all rights that I, my child, or our representatives may have to make claim
against San Bartolome Integrated Highschool or their respective officers, employees, or representatives arising from
injury or damages, including attorney’s fees, that may result from my child’s participation in the Work Immersion
Program.
I further agree to indemnify and hold harmless the cooperating schools or their respective officers, employees, or
representatives from any claims, including attorney’s fees, which I or my child might make or which might be made on
my or our behalf by others, or which might be made against me or my child by others, arising from my child’s
participation in the abovementioned programs.

________________________ ____________________
Signature of Parent/Guardian Date

SBIHS-WI-FORM 2
Republic of the Philippines
Department of Education
Region IVA – CALABARZON
Schools Division of San Pablo City
San Bartolome Integrated High School
Brgy. San Bartolome, San Pablo City, Laguna

SUBSCRIBED AND SWORN TO before me, this__________day of______, ___________exhibiting to me and was
identified by me through his/her competent evidence of identity:
_______________________________________________________________________issued on
__________________________________at, ________________________________.

_____________________________
Notary Public

Until__________________________
IBP No.________________________
PTR No._______________________

Doc. No.___________
Page No.__________
Book no.___________
Series of 20________

SBIHS-WI-FORM 2

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