WAIVER

(On-the-Job Training / Practicum)

This is to certify that I am allowing my son / daughter __________________________________________
(Name of Student)

to undergo On-the-Job Training/Practicum at _______________________________________________

(Name of Company)

from ______________________ to ______________________.

We also hold the Technological Institute of the Philippines free and harmless from any responsibility nor be
held liable whatsoever for any injury, personal or pecuniary, which may happen to him / her and / or caused
by third person within or outside the company premises throughout the duration of the On-the-Job
Training/Practicum.
________________________________________
Parents/Guardians Signature Over Printed Name
Date: __________________________________

________________________________
Students Signature Over Printed Name
Date: ___________________________

ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES)
QUEZON CITY, METRO MANILA) S.S
BEFORE ME, a Notary Public for and in Quezon City this ________ day of ________, personally
appeared:
NAME

CTC NO.

DATE/PLACE ISSUED

All known to me and to be known to be the same persons who executed the foregoing Memorandum of
Agreement, consisting of two (2) pages, signed by them and their witnesses, and they acknowledge that
the same is their voluntary act and deed and also of those whom they represent.
WITNESS MY HAND AND SEAL
DOC. NO. ;
PAGE NO. ;
BOOK NO. ;
SERIES NO

NOTARY PUBLIC