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