PAMANTASAN NG LUNGSOD NG MARIKINA

COLLEGE OF ARTS, SCIENCES, EDUCATION AND CRIMINOLOGY

Guardian’s Certification of Waiver / Permission

This is to certify that I/am allowing my (son/daughter) ______________, to undergo a

practicum (on-the-job-training) for a minimum of _____________ weeks ( ) starting on
_________ until ________ at __________ in partial fulfillment of the requirement for the degree
in Bachelor of Arts in Public Administration in Pamantasan ng Lungsod ng Marikina.

It is understood that ________ abides by the policies and guidelines that may be imposed
by the supervisor/Staff-in-Charge for his/her welfare and safety.

I fully agree to waive that Pamantasan ng Lungsod ng Marikina (PLMAR) and/or the
representative/s are free from any responsibilities in case there are any untoward incidents that
may happen to my ______________ during the duration of the practicum.

____________________________________
Name of Parent/Guardian/Signature/Date

Student’s Name: ______________________________

Home Address: _______________________________

Contact Number: ______________________________

Email address: ________________________________

(In case of emergency)

Contact Person/s: ______________________________

Contact Numbers: ______________________________

Rainbow St. Corner Russet St. SSS Village, Concepcion Dos, Marikina City
plmarikina2003@yahoo.com
PAMANTASAN NG LUNGSOD NG MARIKINA
COLLEGE OF ARTS, SCIENCES, EDUCATION AND CRIMINOLOGY

Rainbow St. Corner Russet St. SSS Village, Concepcion Dos, Marikina City
plmarikina2003@yahoo.com