ANDRES BONIFACIO COLLEGE

School of Engineering
College park, Dipolog City

WAIVER WITH PARENT’S CONSENT

TO WHOM IT MAY CONCERN:

I, JOAN DANIELLE T. LAWAGON of legal age and a student of Andres Bonifacio College with
residence at RIZAL, ZAMBOANGA DEL NORTE do hereby execute this waiver with parental consent that:

The Andres Bonifacio College is ABSOLVED of any liability arising from accident or injury to my
life in my personal intention to participate the ON-THE-JOB TRAINING at PROVINCIAL ENGINEERING
OFFICE (PEO) on APRIL 2017.

Further, I consider and agree myself to the following terms and conditions:

That I will participate in the above mentioned event/activity voluntarily at my own freewill for the
purpose of developing my capacities and to represent the School of Engineering.

That my parents/guardians have given to me their consent, hence they expressly agreed to my
involvement and participation for this undertaking.

We therefore affix our signature this 7th day of April, 2017, Dipolog City, Zamboanga Del Norte,
Philippines.

JOAN DANIELLE T. LAWAGON JOSEPHINE T. LAWAGON

Student Parent

Signed in the presence of:

ENGR. CLARO E. CERVANTES JR. ENGR. CLARO E. CERVANTES JR. JULIUS B. ELOPRE
Instructor Dean DASAS Director

SUBSCRIBED AND SWORN to before me this 7th day of APRIL, 2017, affiant exhibited to me his/her valid
identification no. ,issued by ,which is valid until .

Dic. No. ;
Page No. ;
Book No. ;
Series of 2017.