COLLEGE OF PHARMACY

UR LADY OF FATIMA UNIVERSITY

Sumulong Highway, Sta. Cruz, Antipolo City

WAIVER OF INTERNSHIP

This waiver is executed by Lorina E. Orminita for and in behalf Floriza Leigh E. Orminita who is
required to actively participate and attend the Pharmacy Internship Program as mandated by
the curricular requirements of the course enrolled.

This waiver is a recognition and affirmation that the Our Lady of Fatima University legally
prescribes to the curricular program of the Commission on Higher and that therefore the
UNIVERSITY IS NOT LIABLE for any untoward and unforeseen incident/illness that may occur
as result of the internship/ practicum whether on-site or coming or going to the affiliation/
practicum site.

I hereby agree to the above stated rules and regulations and herein affixed my signature
this 14th day of March 2017 at Antipolo City.

Floriza Leigh E. Orminita Lorina E. Orminita________

Signature of Student over Printed Name Signature of Parent over Printed Name