Republic of the Philippines

Department of Education
Region XI
Schools Division of the Island Garden City of Samal
SAMAL SENIOR HIGH SCHOOL
SITO PASIG, PEÑAPLATA, SAMAL District, Island Garden City of Samal

PARENTAL CONSENT
I __________________________________________________ (name of parent/guardian) grant my permission for
__________________________________________ (name of son/daughter) to participate in this activity to be undertaken at
___________________________________ that will be occurring on _________________________.

Sincerely,
_________________________________________________
Name of Parent/Guardian

STUDENT WAIVER
I, ___________________________________ (name) presently enrolled in Samal Senior High School ,
____________________________________(track/strand) present myself to participate the Work Immersion
determine whether I can perform to the standard expected in the workplace based on the defined competency
standards.

Do hereby pledge that:

1. I will obey and abide by the rules and regulations promulgated, enforced by the school for the protection and
safety of all;

2. That I hereby waive and renounce my rights to all damages, hospitalization, and the like, and I will not hold the
school or teachers of MUST responsible for any misfortune, injury, or accident, be it slight or serious, that may
happen in connection with the activities or requirements. The cause of which will be attributable to my acts of my
disobedience, negligence, and the offense of my heading to advice, warning, precaution, and safety rules that were
read to me by my teacher before the start of the activity.

3. That the content of this waiver was read and explained to me before I affix my name and signature this ______
day of ______________freely and voluntarily. Thank you very much!

Yours truly,
__________________________________
(Name of student)

Signed:
LILIAN L. AVANCE PERCIVAL C. VILLEGAS
Work Immersion Teacher Principal I

Address: Sitio Pasig, Peñaplata , Samal District, Island Garden City of Samal
Contact No.: 09092060818
E-mail Address: 341526@deped.gov.ph