Republic of the Philippines

Department of Education
Schools Division Office I Pangasinan
PANGASINAN SCHOOL OF ARTS AND TRADES
Lingayen, Pangasinan

PARENTS / GUARDIAN WAIVER

TO WHOM IT MAY CONCERN:

I / We, Mr. /Mrs. / Ms. ___________________________________________________

(Parent / Guardian)
of Ms. / Mr. ________________________________________________________________ ,
do hereby given consent and allow him/her to have his/her Work Immersion for 80 hours

starting _____________________________ until _______________________________ at

____________________________________________________________________________
(Company name and Address)

I further release my son / daughter from any liabilities and obligations arising from
the said activity and I / we hereby waive any and all claims and demand that we
may
have against the School, School Administrator, and Teacher in relation to the
participation
of our son / daughter.

Done this __________ of _____________________, 2023 at Lingayen, Pangasinan.

Day Month

_________________________________________________________
Parent / Guardian
(Signature over Printed Name)
Contact Number of Parents / Guardian : ____________________________

Contact Number of Student : ____________________________