TARLAC STATE UNIVERSITY

VICE PRESIDENT for ACADEMIC AFFIAIRS

PARENTAL PERMIT

WAIVER

This is to certify that I, _______(name of parent / guardian)_________ parent/guardian of

_________(name of student)__________, a bona fide student of Tarlac State University grant
him/her permission to undergo internship/on-the-job training at the ___(name of company)_____,
located at ___(address of the company)_ from _______________ to ____________.

I understand and agree that this training is necessary and a requirement for the completion
of the degree Bachelor of ______________________________.

I further agree and affirm that Tarlac State University and ____(name of company)____are
in no way responsible nor shall they pay compensation for any incident, harm, or injury that may
be caused on his/her person during the training and that my child will undergo said on-the-job
training.

I also certify that s/he on her/his free will, certified to me her/his decision to undergo on-
the-job training as evidence by her/his signature affixed below together with my own signature.

_____________________________ _____________________________
NAME AND SIGNATURE NAME AND SIGNATURE
Student Parent/Guardian

Noted:

_____________________________ _____________________________
NAME AND SIGNATURE NAME AND SIGNATURE
Internship Supervisor Dean

Form No.: TSU-VPA-SF- 26 Revision No.: 00 Effectivity Date: January 25, 2017 Page 1 of 1