WAIVER/UNDERTAKING

We, ___________________________________________ (student-trainee) and

___________________________________ (parent/guardian), hereby execute
this Waiver/Undertaking to hold the Polytechnic University of the Philippines and
the training institution, free from any liability for any injuries/illness/loss of life or
property that may be incurred/sustained by the student-trainee in the course
his/her observation/on-the-job/practicum with the training institution provided that
the same is not due to any willful criminal act or gross negligence of the training
institution or any of its representatives, officers or employees.

As the parent/guardian of the student/trainee, I hold myself responsible from any

expenses that may be incurred as a result of the student’s illness, injury, death or
loss of property in the course of the student’s observation/on-the-job
training/practicum, except as provided above. I further undertake to be responsible
for any breakage, loss of property, damage, death, or injury that may be caused
by the student-trainee to any part while undergoing training.

We execute this Waiver/Undertaking in accordance with our free will, realizing the
benefits that the student-trainee shall obtain from the said observation/on-the-job
training/practicum.

__________________________ __________________________
(Printed Name and Signature of (Printed Name and Signature of
Student-Trainee) Parent/Guardian)