ADVENTIST MEDICAL CENTER COLLEGE

DEPARTMENT OF PHARMACY

INTERNSHIP WAIVER

I, ________________________________________________ (Complete Name of Student), am allowed

by my parent/guardian, _____________________________________ (Complete Name of
Parent/Guardian) to proceed with the Public Health and Regulatory Experiential Pharmacy Practice
Internship Program this October, 2022, provided that I understand and will uphold the rules and
regulations of Adventist Medical Center College (AMCC) – Department of Pharmacy.

With full knowledge, I agree that I am to:

 Follow the rules and regulations of the training institution where I am assigned.
 Submit the required documents prior to the starting day of internship.
 Complete the internship program according to the given activities set by the
preceptor/supervisor of the establishment despite of the risks of the current COVID-19
pandemic.
 Be trusthworthy in all circumstances in the duration of the training program.
 Report to the establishment preceptor immediately when there will be a time I cannot attend to
my duty schedule.

I further agree to waive and release any and all rights that I and my representatives may have to make
claim against Adventist Medical Center College and Philippine Drug Enforcement Agency (PDEA) as my
training institution and their respective officers, employees, or representatives arising from injury or
damages, including attorney fees that may result from my Internship Program when there is gross
negligence in my part.

Signature above printed name of Student Date

Signature above printed name of Parents/Guardian Date

Note: Please attach a photocopy of Parent’s valid ID.