Republic of the Philippines

JOSE RIZAL MEMORIAL STATE UNIVERSITY

The Premier University in Zamboanga del Norte
Gov. Guading Adaza St., Sta. Cruz, Dapitan City
Province of Zamboanga del Norte
COLLEGE OF EDUCATION

LIABILITY WAIVER

TO WHOM IT MAY CONCERN:

This is to certify that I, __________________________________________, a

___________________ student of Jose Rizal Memorial State University have been granted
permission by the school administration to undergo Field Study 1 and 2 at
_________________________________________ from ______________ to ______________,
______ with the equivalent of ________ hours.

Further, I hereby voluntarily agree to undergo the said training in the school stated above in
order to acquire actual work experience with the following terms and conditions:

1. I understand that the school will not be held liable for any untoward incident that may
happen while on my way to and from training school and/or in the performance of my
duties and functions while under training.
2. That I shall abide to the school’s rules and regulation and shall comply with the imposed
requirements for the Student Teaching, otherwise, I shall be excluded from further
participation.
3. That I shall exercise care and diligence in any duties and tasks assigned to me.
4. That I shall be made answerable in all liabilities for damage of property or injury to third
person who may be occasioned by international or negligent acts while in the course of
my training.

Signed on the ____ day of ________________, _________ at __________________ Philippines.

________________________
Student’s Signature

Received:

___________________________
School Principal