UNIVERSITY OF CAGAYAN VALLEY

(formerly Cagayan Collages Tuguegarao)

Balzain Campus, Tuguegarao City, Cagayan Valley, Philippines

SCHOOL OF LIBERAL ARTS AND TEACHER EDUCATION

ASSENT AND CONSENT FORM

I, Sherwin C. Tamayao (name of the Teacher Intern), read and understand the guidelines in teaching internship. I
also know that this undertaking is part of the curriculum in order to finish my degree. I am aware that I
need to finish 360 hours of teaching internship which is a requirement to finish my degree.

Therefore, we, Sherwin C. Tamayao (name of the Teacher Intern) and Nena C. Tamayao (name of Parent/Guardian),
hereby execute this Waiver/ Undertaking to hold the University of Cagayan Valley and Tuguegarao City
Science High School (name of Cooperating School) ,free from any liability for any injury / illness / loss of life or
property that may be incurred/ sustained by the teacher intern in the course of his/ her on-the-job-
training / practicum with the training institution provided that the same is not due to any willful criminal
act or gross negligence of the training institution or any of its representatives, officers or employees.

As the parent/ guardian of the teacher intern, I hold myself responsible for any expenses that may be
incurred as a result of my child’s illness, injury, death or loss or property in the course of my child’s on-
the-job-training/ practicum, except as provided above. I further undertake to be responsible for any
breakage, loss of property, damage, death or injury that may be caused by my child to any party while
undergoing training.

We execute this Waiver/ Undertaking in accordance with our free will, realizing the benefits that my child
shall obtain from the said on-the-job training / practicum.

SHERWIN C. TAMAYAO NENA C. TAMAYAO

Printed Name and Signature Printed Name and Signature
Teacher Intern Parent / Guardian
Student’s Copy

UNIVERSITY OF CAGAYAN VALLEY

(formerly Cagayan Collages Tuguegarao)
Balzain Campus, Tuguegarao City, Cagayan Valley, Philippines

SCHOOL OF LIBERAL ARTS AND TEACHER EDUCATION

ASSENT AND CONSENT FORM

I, Sherwin C. Tamayao (name of the Teacher Intern), read and understand the guidelines in teaching internship. I
also know that this undertaking is part of the curriculum in order to finish my degree. I am aware that I
need to finish 360 hours of teaching internship which is a requirement to finish my degree.

Therefore, we, Sherwin C. Tamayao (name of the Teacher Intern) and Nena C. Tamayao (name of Parent/Guardian),
hereby execute this Waiver/ Undertaking to hold the University of Cagayan Valley and Tuguegarao City
Science High School (name of Cooperating School) ,free from any liability for any injury / illness / loss of life or
property that may be incurred/ sustained by the teacher intern in the course of his/ her on-the-job-
training / practicum with the training institution provided that the same is not due to any willful criminal
act or gross negligence of the training institution or any of its representatives, officers or employees.

As the parent/ guardian of the teacher intern, I hold myself responsible for any expenses that may be
incurred as a result of my child’s illness, injury, death or loss or property in the course of my child’s on-
the-job-training/ practicum, except as provided above. I further undertake to be responsible for any
breakage, loss of property, damage, death or injury that may be caused by my child to any party while
undergoing training.

We execute this Waiver/ Undertaking in accordance with our free will, realizing the benefits that my child
shall obtain from the said on-the-job training / practicum.

SHERWIN C. TAMAYAO NENA C. TAMAYAO

Printed Name and Signature Printed Name and Signature
Teacher Intern Parent / Guardian
Office Copy
 UNIVERSITY OF CAGAYAN VALLEY
(formerly Cagayan Collages Tuguegarao)
Balzain Campus, Tuguegarao City, Cagayan Valley, Philippines

SCHOOL OF LIBERAL ARTS AND TEACHER EDUCATION

ASSENT AND CONSENT FORM

I, Sherwin C. Tamayao (name of the Teacher Intern), read and understand the guidelines in teaching internship. I
also know that this undertaking is part of the curriculum in order to finish my degree. I am aware that I
need to finish 360 hours of teaching internship which is a requirement to finish my degree.

Therefore, we, Sherwin C. Tamayao (name of the Teacher Intern) and Nena C. Tamayao (name of Parent/Guardian),
hereby execute this Waiver/ Undertaking to hold the University of Cagayan Valley and Tuguegarao City
Science High School (name of Cooperating School) ,free from any liability for any injury / illness / loss of life or
property that may be incurred/ sustained by the teacher intern in the course of his/ her on-the-job-
training / practicum with the training institution provided that the same is not due to any willful criminal
act or gross negligence of the training institution or any of its representatives, officers or employees.

As the parent/ guardian of the teacher intern, I hold myself responsible for any expenses that may be
incurred as a result of my child’s illness, injury, death or loss or property in the course of my child’s on-
the-job-training/ practicum, except as provided above. I further undertake to be responsible for any
breakage, loss of property, damage, death or injury that may be caused by my child to any party while
undergoing training.

We execute this Waiver/ Undertaking in accordance with our free will, realizing the benefits that my child
shall obtain from the said on-the-job training / practicum.

SHERWIN C. TAMAYAO NENA C. TAMAYAO

Printed Name and Signature Printed Name and Signature
Teacher Intern Parent / Guardian
Student’s Copy

UNIVERSITY OF CAGAYAN VALLEY

(formerly Cagayan Collages Tuguegarao)
Balzain Campus, Tuguegarao City, Cagayan Valley, Philippines

SCHOOL OF LIBERAL ARTS AND TEACHER EDUCATION

ASSENT AND CONSENT FORM

I, Sherwin C. Tamayao (name of the Teacher Intern), read and understand the guidelines in teaching internship. I
also know that this undertaking is part of the curriculum in order to finish my degree. I am aware that I
need to finish 360 hours of teaching internship which is a requirement to finish my degree.

Therefore, we, Sherwin C. Tamayao (name of the Teacher Intern) and Nena C. Tamayao (name of Parent/Guardian),
hereby execute this Waiver/ Undertaking to hold the University of Cagayan Valley and Tuguegarao City
Science High School (name of Cooperating School) ,free from any liability for any injury / illness / loss of life or
property that may be incurred/ sustained by the teacher intern in the course of his/ her on-the-job-
training / practicum with the training institution provided that the same is not due to any willful criminal
act or gross negligence of the training institution or any of its representatives, officers or employees.

As the parent/ guardian of the teacher intern, I hold myself responsible for any expenses that may be
incurred as a result of my child’s illness, injury, death or loss or property in the course of my child’s on-
the-job-training/ practicum, except as provided above. I further undertake to be responsible for any
breakage, loss of property, damage, death or injury that may be caused by my child to any party while
undergoing training.

We execute this Waiver/ Undertaking in accordance with our free will, realizing the benefits that my child
shall obtain from the said on-the-job training / practicum.

SHERWIN C. TAMAYAO NENA C. TAMAYAO

Printed Name and Signature Printed Name and Signature
Teacher Intern Parent / Guardian
Office Copy