Reference No.: BatStateU-FO-OJT-01 Effectivity Date: May 18, 2022 Revision No.

: 02

PARENT’S/GUARDIAN’S CONSENT FORM FOR INTERNSHIP TRAINING

AUGUST 31, 2022

Date

TO ALL CONCERNED:

I, LUCIA B. MAGPANTAY grant permission for my child/ward, JOSUA B MAGPANTAY

a 5th yr. student of BS MECHANICAL ENGINEERING of the COLLEGE OF ENGINEERING

of this University, to undergo internship training in any educational institution/industrial firm or establishment in order to acquire work experience related to the academic training.

Further, as the Parent/Legal guardian, I also recognize that there may be risks attribute to the internship training which can only be avoided through my son’s/daughter’s/ward’s extra diligence and
due care, which I fully explained to my son/daughter/ward.

By signing this document, it is understood that my child/ward:

a) Has been properly oriented with all the rules and regulations in the conduct of internship training and that there may be additional rules and instructions that may be given from time to time. It
is further understood that he/she must comply with the aforesaid rules, regulations and instructions; otherwise, he/she shall be excluded from further participation.
b) Shall abide by all the company /school rules and regulation and shall comply with those imposed for the program; otherwise, he/she shall be excluded from the further participation;
c) Shall exercise care and diligence in any task assigned to him/her;
d) Shall be made answerable for any and all liabilities for damages for property or injury to third person, which may be occasioned by his/her intentional or negligent act while in the course of
his/her training.

Pursuant to Republic Act No. 10173, also known as the Data Privacy Act of 2012, the Batangas State University, the National Engineering University, recognizes its commitment to protect and respect the
privacy of its customers and/or stakeholders and ensure that all information collected from them are all processed in accordance with the principles of transparency, legitimate purpose and proportionality
mandated under the Data Privacy Act of 2012.

MAGPANTAY, LUCIA B. DDDDDD

(Signature over Printed Name of Parent/Guardian)

Contact Number: 09555527412

Address: SITIO GULOD BRGY. MASALUKOT IV CANDELARIA, QUEZON

Conforme:
MAGPANTAY, JOSUA B.
(Signature over Printed Name of Student)

Name of OJT Coordinator: ENGR. LENDON S. ARCILLAS