SAN PEDRO COLLEGE

NURSING DEPARTMENT

BSN 3 CLINICAL POLICIES/GUIDELINES ORIENTATION

CONFIRMATION FORM

NAME : KENT TROI P. BARNES

YEAR & SECTION : BSN-3M

HOME ADDRESS : KATIPUNAN, NABUNTURAN, DAVAO DE ORO

TEL. NO./ MOBILE NO. : 09505462447

FATHER’S NAME : REY M. BARNES

MOTHER’S NAME : BASILISA P. BARNES

GUARDIAN’S NAME : BASILISA P. BARNES

I attended the virtual clinical orientation, read and understood all the
contents of the clinical orientation for the BSN Related Learning Experiences.

I pledge to the management of the Nursing Department of San Pedro

College that I shall abide with the policies, rules, and regulations pertinent to
the academic, non-academic and clinical requirements.

KENT TROI P. BARNES

Student Nurse Printed Name & Signature

BASILISA P. BARNES
Parent’s/Guardian’s Name & Signature

8-12-2021
Date Signed
 **please send screenshot of parent/guardian’s ID showing the signature above

PASTE HERE screenshot of Parent’s/Guardian’s ID: