STUDENT’S CONSENT FORM FOR BLENDED MODE OF INTERNSHIP TRAINING

IJOSUA B. MAGPANTAY, a student of BATANGAS STATE UNIVERSITY, BATANGAS

CITY, hereby voluntarily agree to undergo internship training in blended mode (remote mode and limited
face-to-face mode) in any partner industry/institution/agency in order to acquire work experience related
to the academic training gained from the College of ENGINEERING under the following terms and
conditions:

1. That I shall strictly abide by all the partner industry/institution/agency rules and regulation which
includes the safe and health protocols and shall comply with those imposed for the program;
otherwise, I shall be excluded from further participation;
2. That I shall be transparent in declaring health condition, including those of family members
3. That I shall exercise care and diligence in any task assigned to me;
4. That I shall renounce and waive my claim against the partner industry/institution/agency for any
injury or illness I suffer personal or pecuniary, in the performance of my duties and function
while under training;
5. That I shall be made answerable for any and all liabilities for damages for property or injury to
third person, which may be occasioned by my intentional or negligent act while in the course of
my training.

Signed on this AUGUST day Of 31, 2022 at CANDELARIA, QUEZON ,Philippines.

MAGPANTAY, JOSUA B.
Student’s Signature over Printed Name

With our consent and approval:

MAGPANTAY, LUCIA B.
Signature of Parents/Guardian over Printed Name