Republic of the Philippines

Courses Offered:
MARINDUQUE STATE COLLEGE Boac Campus:
BS Information Technology
COLLEGE OF ENGINEERING, INFORMATION AND INDUSTRIAL TECHNOLOGY BS Information Systems
(AACCUP, Inc. Reaccredited Level 3)
INSTITUTE OF INFORMATION SYSTEM AND TECHNOLOGY Santa Cruz Campus:
Panfilo M. Manguera Sr. Rd., Tanza, Boac, Marinduque BS Information Systems
(AACCUP, Inc. Reaccredited Level 2)
IIST Tel. No.: (042) 704-0193 IIST E-mail Address: sics.msc@gmail.com
Website: www.mscmarinduque.edu.ph

PARENT’S / GUARDIAN’S CONSENT AND WAIVER

TO WHOM IT MAY CONCERN:

This is to certify that I gave my consent to my son/daughter,

___________________________________ to undergo a Practicum/Internship/On-the-Job
Training for 900 hours, from March 2022 to May 2022 at College of Engineering,
Information and Industrial Technology in partial fulfillment of the requirements for the degree
Bachelor of Science in Industrial Technology
___________________________________________.

It is understood that he/she will abide by the rules and regulations that may be imposed by
the Marinduque State College as Higher Education Institution (HEI) and the
_____________________________________________________________________, as Host
Training Establishments (HTE) for his welfare and safety.

I fully agree to waive any responsibility on the part of the Higher Education Institution (HEI)
and Host Training Establishments (HTE), in case of untoward incident that may happen to my
son/daughter during the duration of the practicum which are beyond their control or due to my
son/daughter’s negligence.

___________________________ ______________ 02/09/2022

Name of Guardian Signature Date

Student’s Name : ___________________________________________________________

Home Address : ___________________________________________________________
Boarding House Address : _______________________________________________________
Student’s Contact Number/s : _____________________________________________________
Parent/Guardian’s Contact Number/s : ______________________________________________

Subscribed and sworn to before me this _______day of _______________at _______________.

_______________________
Notary Public