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EX VALLEY HIGH ACADEMY, INC. ‘ “
GEA) eagqeron anconnrannte
WORK IMMERSION WAIVER FORM
[2 ysotd and an (1/2. sestet of
Senior High Schol withthe Law no. 096 Lb [20 1-2
lan
As a requirement for my graduation from Secondary Education, _ ABZ __strand, | shall be
undergoing work immersion for a total of {i0 hours starting on yal (f_—_—_untl_May 14
In relatiofto the said Work immersion:
11. will dress appropriately and conform tothe standards of conduct required at my workimmersion
site
2. I will arrive atthe site before the agreed time, or if! am not able to attend in the appointment
day and/or time, cal the site direct supervisor and the teacher in-charge at_Z 50) before the
schedule time.
3. I willfollow workplace safety and security measures, policies, regulations, procedures and strictly
‘observe confidentiality of business information.
4. | will take it as my responsiblity the necessary precautions in any incident that could «
damage or injury to myself or that of another.
5. | understand that | must be physical ft to work. Incase, medical abstracts required.
6. | will inform my parents or guardians of the nature of work/task/activty glven/ assigned by the
direct supervisor.
7. will report at my worksite fram 8 am to 12:00 nn, Mondays to Fridays. In case there are changes
in schedule, | will notify my Work Immersion Teacher and Supervisor in the school.
8. hereby attest that | have read and understand all the conditions indicated above.
Signature of Student over printed name
Date:
Contact Number:
Work immerse Teacher
Noted by:
Recind _S OPINO LT, CLESYB
Schoo! Head
