Waiver and Permission Form

This is to certify that I am permitting my

son/daughter,___________________________________to undergo an internship training program
for a total of _______hours starting on _____________until ,
a t ____________________________________________ , in partial fulfillment of the
requirements for the degree of Bachelor of Science in Business Administration major in
__________________________.

My son/daughter understands that he/she should strictly observe the rules and regulations of
______ ‘s (insert name of the institution or company where the internship training is to be conducted)
and UST, in relation to the said training program and to observe all other regulations that may be
implemented by his/her direct supervisor in relation to the same.

I hereby agree to waive any responsibility on the part of the University of Santo Tomas
in relation to any loss, damage, death, injury or accident that may happen to my son/daughter
during the said internship training, unless such loss, damage, injury, accident or death resulted
from the fault or gross negligence of UST.

I also hereby agree to hold render UST free and harmless, including its officers, employees or
agents, from any liability, suit or claim filed or made by any party for any injury (including
death) or damage to property that my son/daughter may cause due to his/her willful acts, fault or
negligence, whether or not the same arises from or is related to his/her internship training.

I have likewise read the Internship Waiver Form signed by my son/daughter and is fully
agreeable with all the things stated thereon.

_______________________ __________________ ____________

Name of Father Signature Date

_______________________ __________________ ____________

Name of Mother Signature Date

_______________________ __________________ ____________

Name of Guardian Signature Date

Name of Student: ___________________________________

Home Address: ___________________________________
Telephone No.: ___________________________________
Mobile No.: ___________________________________
UST:A009-00-FO17