EMILIO AGUINALDO COLLEGE

Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

SCHOOL OF NURSING
RELATED LEARNING EXPERIENCE
(SKILLS LABORATORY)
WAIVER

I do hereby acknowledge that my son/daughter, who is presently enrolled in Emilio Aguinaldo College, School
of Nursing, will be scheduled for Related Learning Experience (RLE) this Semester/ Summer,
Academic
Year - , Level , Section , Group .

I am fully aware that my son/daughter will be undergoing a return demonstration as a requirement of the
course ________________________________ on the following schedule:

Inclusive date and Topic/ Discussion Clinical Instructor

Procedure
time

I hereby release Emilio Aguinaldo College and the School of Nursing from any liability should any untoward
circumstances occur during the return demonstration.

___________________________ _______________
Student’s Name Date Signed

____________________________ _______________
Parent/Guardian’s Name Date Signed

Witness:

______________________ _______________
Clinical Coordinator Date Received

Noted by:

Arnel G. Pantoja, MSN, RN _______________

School Dean Date Signed

– – – – – – – – – – – – – – – – – – – – – – – – – –Parent’s Copy– – – – – – – – – – – – – – – – – – – – – – – –

QF-SON-028 (03.17.2022) Rev.02

• VIRTUE • EXCELLENCE • SERVICE

 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

SCHOOL OF NURSING
RELATED LEARNING EXPERIENCE
(SKILLS LABORATORY)
WAIVER

I do hereby acknowledge that my son/daughter, who is presently enrolled in Emilio Aguinaldo College, School
of Nursing, will be scheduled for Related Learning Experience (RLE) this Semester/ Summer,
Academic Year - , Level , Section , Group .

I am fully aware that my son/daughter will be undergoing a return demonstration as a requirement of the
course ________________________________ on the following schedule:

Inclusive date and Topic/ Discussion Clinical Instructor

Procedure
time

I hereby release Emilio Aguinaldo College and the School of Nursing from any liability should any untoward
circumstances occur during the return demonstration.

____________________________ _______________
Student’s Name Date Signed

____________________________ _______________
Parent/Guardian’s Name Date Signed

Witness:

______________________ _______________
Clinical Coordinator Date Received

Noted by:

Dr. Arlene P. Corpus, PhD, MAN _______________

School Dean Date Signed

– – – – – – – – – – – – – – – – – – – – –School of Nursing’s Copy– – – – – – – – – – – – – – – – – – – – – –

QF-SON-028 (03.17.2022) Rev.02

• VIRTUE • EXCELLENCE • SERVICE