University of the Philippines Manila

COLLEGE OF ALLIED MEDICAL PROFESSIONS

The ealth S!ien!es Center
UP Manila Compound, P. Gil St. Malate, 1004 Manila, Philippines
e-mail address: camp@mail.upm.edu.ph we site: www.upm.edu.ph!camp

CONFORME
This is to certify that I was oriented to the _______________________________________________
(Course Number & Activity)

Its policies and guidelines I declare that: The activity is a requirement for the course The activity covers a period of ___________________________________ I will abide by the policies/guidelines set by the college; I understand that appropriate action/s/consequence/s may be charged upon me or non-compliance or any policy/requirement; and I will submit all the requirement set by the college on time. ame of student: ____________________________________ !ignature: ____________________________________ "ate: ____________________________________

WAIVER
To whom it may concern: I have read and understood the #$ourse umber % &ctivities' ___________________________ ob(ectives) policies and procedures. I understand that successful completion of the activity is a requirement for #$ourse number'_____________) and that my son/daughter/ward ______________________ is required to go out on such fieldwor*. I understand that the $ollege of &llied +edical ,rofessions) -niversity of the ,hilippines +anila will assign my son/daughter/ward to go to _______________________________. Travel arrangements to and from the assigned facility are the responsibility of my son/daughter/ward. .e hereby hold the -, +anila free and harmless from and bound ourselves to indemnify the -niversity for any claim or any damage or suit that may be filed) instituted or arise in connection with the abovementioned activity. ame of parents/guardian: ____________________________ !ignature: ____________________________ "ate: ____________________________