Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A –CALABARZON
Division of Laguna
STA. MARIA INTEGRATED HIGH SCHOOL
Santa Maria Laguna
TO WHOM IT MAY CONCERN:

This is to certify that I, __________________________________ parent of ______________________________, a student

of Sta. Maria Integrated High School-Technical Vocational and Livelihood Track, hereby authorize him/her to undergo WORK
IMMERSION at ____________________________________________with office address at
____________________________________________________________.

I further affirm that Sta. Maria Integrated High school shall not be responsible for any accident or injury that may befall on
this person while on his/her way to and from the site of the work immersion particularly using a motorcycle as mode of transportation.
I also fully understand that while he/she is undergoing such immersion, the partner institution concerned will not be held liable for any
injury arising from the circumstances due to the fault of the student while within its compound. Further, the partner institution will see
to it that the above named student be given an orientation concerning the partner institution’s safety program.

Student’s signature over printed name Parent’s signature over printed name

Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A –CALABARZON
Division of Laguna
STA. MARIA INTEGRATED HIGH SCHOOL
Santa Maria Laguna
TO WHOM IT MAY CONCERN:

This is to certify that I, __________________________________ parent of ______________________________, a student

of Sta. Maria Integrated High School- Technical Vocational and Livelihood Track, hereby authorize him/her to undergo WORK
IMMERSION at _____________________________________________________with office address at
____________________________________________________________.

I further affirm that Sta. Maria Integrated High school shall not be responsible for any accident or injury that may befall on
this person while on his/her way to and from the site of the work immersion particularly using a motorcycle as mode of transportation.
I also fully understand that while he/she is undergoing such immersion, the partner institution concerned will not be held liable for any
injury arising from the circumstances due to the fault of the student while within its compound. Further, the partner institution will see
to it that the above named student be given an orientation concerning the partner institution’s safety program.

Student’s signature over printed name Parent’s signature over printed name

Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A –CALABARZON
Division of Laguna
STA. MARIA INTEGRATED HIGH SCHOOL
Santa Maria Laguna
TO WHOM IT MAY CONCERN:

This is to certify that I, __________________________________ parent of ______________________________, a student

of Sta. Maria Integrated High School- Technical Vocational and Livelihood Track, hereby authorize him/her to undergo WORK
IMMERSION at _____________________________________________________with office address at
____________________________________________________________.

I further affirm that Sta. Maria Integrated High school shall not be responsible for any accident or injury that may befall on
this person while on his/her way to and from the site of the work immersion particularly using a motorcycle as mode of transportation.
I also fully understand that while he/she is undergoing such immersion, the partner institution concerned will not be held liable for any
injury arising from the circumstances due to the fault of the student while within its compound. Further, the partner institution will see
to it that the above named student be given an orientation concerning the partner institution’s safety program.

Student’s signature over printed name Parent’s signature over printed name