National University

Manila
College of Engineering
Industry Internship Training Program
Waiver Form
This is to certify that I am allowing my son/daughter, ___________________________,
to undergo industry immersion for at least two hundred forty (240) hours, starting on
_______________ until _______________, at ________________________________,
in partial fulfilment of his/her requirements for the degree of Bachelor of Science in
___________________________.
It is expected that he/she strictly adheres to the policies, rules, and regulations of the
company, the Industry Internship Training Program of the University, and all other rules
that may be imposed by his/her training supervisor.
I hereby agree to waive any responsibility on the part of the National University,
___________________________, and/or representatives in relation to any loss,
damage, death, injury or accident that may happen to my son/daughter in the duration
of the practicum training.
I have read and understood this document and I acknowledge my responsibilities and
the effect of this document.

_________________________
Parent/Guardian
(Signature Over Printed Name)
Date: ____________________
Name of Student: ___________________________
Address: __________________________________
Telephone: ________________________________
Mobile Phone: _____________________________