SAN PEDRO COLLEGE

SCHOOL OF NURSING

BSN 3 CLINICAL POLICIES/GUIDELINES ORIENTATION

CONFIRMATION FORM

NAME : Al-Khusairy A. Tuansi

YEAR & SECTION BSN-3B

HOME ADDRESS : Birsaba Street, Buhangin, Davao City, Davao del sur

TEL. NO./ MOBILE NO. : 09150266910

FATHER’S NAME : Bajury B. Tuansi

MOTHER’S NAME : Arbaina A. Tuansi

GUARDIAN’S NAME : Arbaina A. Tuansi

I attended the virtual clinical orientation 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 by the policies, rules, and regulations pertinent to
the academic, non-academic, and clinical requirements.

Al-Khusairy Tuansi
Student Nurse Printed Name & Signature

Parent’s/Guardian’s Name & Signature

August 15, 2022

Date Signed
**please send a screenshot of the parent/guardian’s ID showing the signature above

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