FM-AA-INT-18

Rev. 0
01-Feb-2017

TRAINING AGREEMENT AND

LIABILITY WAIVER FORM

I, ____________________________, a student of Pangasinan State University, hereby voluntarily agree

to undergo overtime training in my Internship Training at ____________________________ under the
following terms and conditions:

a. That I have consent from my parents/guardians for the said overtime.

b. That the company/establishment where I am undergoing my training has knowledge of the
overtime.
c. That I fully understand that the Pangasinan State University and __________________________
is no longer responsible/liable for any injury or incident that may occur during the said overtime.

____________________________
Student-Intern

Res. Cert No.: _________________

Issued on: ____________________
Issued at:_____________________

With our consent and approval:

____________________________ ____________________________
Parent/Guardian Company Representative

Res. Cert No.: _________________ Res. Cert No.: _________________

Issued on: ____________________ Issued on: ____________________
Issued at:_____________________ Issued at:_____________________

SUBSCRIBED AND SWORN BEFORE ME this ______ day of _____________, ______ at

____________________________, Philippines.