Republic of the Philippines Form No.

: FM -DPM- CFCST OJT—03

Issue Status 02
COTABATO FOUNDATION COLLEGE OF SCIENCE AND TECHNOLOGYRevision No. 01
Barangay Doroluman, Arakan, Cotabato Date Effective : 02,November, 2021
Approved by : President
Contact No. +639685331496 / +639670025670
Email Address: admin@cfcst.edu.ph Website: www.cfcst.edu.ph

COLLEGE OF EDUCATION
Parent/Guardian’s Certification of Waiver

This is to certify that I am allowing my son/daughter _____________________________, to go on

Field Study for a minimum of 560 hours under CHED Memorandum Order No. 74, 75, 78, 80 series 2017
starting on _________________ until ________________ at _________________________________ in
partial fulfillment of the requirements for the degree of ________________________________________.

It is understood that he/she abides by the rules and regulations that may be imposed by the
supervisor/staff-in-charge for his/her welfare and safety.

I fully agree to waive any responsibility on the part of Cotabato Foundation College of Science and
Technology and __________________________(Cooperating School) and for the representative/s, in case of
any untoward incident that may happen to my son/daughter during the duration of the practicum.

________________________________ ____________________________
FS Student/Trainee Parent/Guardian

Date:_________________________ Date:_____________________

In case of emergency, please notify:

Name : ______________________________
Address : ______________________________
Contact Number : ______________________________