SURIGAO EDUCATION CENTER

Km. 2, National Highway, 8400 Surigao City, Philippines

College of Allied Medical Sciences

WAIVER
Limited Face to Face Classes
Clinical Duty
Caraga Regional Hospital

TERESITA P. ADOBAS, RN, MN

Dean- College of Allied Medical Sciences

Madam,

I, _________________________parent/guardian hereby certify that I allow my

son/daughter, ______________________ to join the hospital duty at Caraga Regional
Hospital during the entire duration of clinical duty as a requirement for graduation for
___________________________.
(Degree Program)

That, I am fully aware of the details of the student activities, that they are
required to abide with the rules and regulations during the entire duration of hospital
duty. Any violation committed thereof, shall be a legitimate ground for sanctions.

With my son/daughter’s clinical duty at Caraga Regional Hospital, I relieve the

hospital of any responsibility to untoward incidents and inevitable circumstances that
may arise during the students’ entire duration of hospital duty.

Affixing my signature to attest that, I fully understand and agree to the

instructions, policies and guidelines hospital duty.

----------------------------------------------- Contact Numbers (smart) 1. --------------------

Signature over printed name (Parent/Guardian (globe) 2. ---------------------

Name of student: ________________

ISO 9001:2015 Certified Institution

www.sec.edu.ph|sec.admin.edu.ph
Tel/Fax.: (086) 826-2007 / 231-7048