Sacred Heart College of Lucena City, Inc.

1 Merchan Street, Lucena City

Contact Numbers: (042) 7103888 / (042) 7102505
Member: Daughters of Charity – St. Louise de Marillac Educational System (DC-SLMES)

BASIC EDUCATION DEPARTMENT

PARENT’S/GUARDIAN’S CERTIFICATION OF WAIVER
SY 2022-2023

Date :___________________________

TO WHOM IT MAY CONCERN:

This is to certify that I am allowing my daughter/son

_____________________________________ to take his/her Work Immersion program
at __________________________________________ for 80 hours on April 10 – 25,
2023 in partial fulfillment of the requirements for the Senior High School Program.

I also understand that he/she is expected to abide by the rules and regulations set by the
Sacred Heart College Work Immersion Program and the Host Training Establishment.

I fully and voluntarily waive my right to hold Sacred Heart College of Lucena City, Inc.
and its representatives and the Host Training Establishment or its representatives
responsible or liable for any case of untoward incident that might happen to her/him
during the performance of her/his Work Immersion.

______________________________________
Parent/Guardian Signature Over Printed Name

____________________
Date Signed