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Waiver Form

The document is a waiver form from AMA Computer College - Dumaguete Inc. releasing the school from liability for any injuries sustained by a student during an on-the-job training placement. It specifies the student's name, placement agency, dates of placement, and is signed by the student's parent/guardian in agreement. The form is noted by the school's Work Immersion Coordinator and Dean.

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Gerard Anthony Teves Rosales
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126 views

Waiver Form

The document is a waiver form from AMA Computer College - Dumaguete Inc. releasing the school from liability for any injuries sustained by a student during an on-the-job training placement. It specifies the student's name, placement agency, dates of placement, and is signed by the student's parent/guardian in agreement. The form is noted by the school's Work Immersion Coordinator and Dean.

Uploaded by

Gerard Anthony Teves Rosales
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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AMA COMPUTER COLLEGE-DUMAGUETE INC.

2F Uymatiao Bldg., Cor. San Jose & Perdices Sts.,


Dumaguete City, Negros Oriental
SENIOR HIGH SCHOOL DEPARTMENT

WAIVER FORM

Mr. ROLANDO M. ROSALES


School Director
AMA Computer College – Dumaguete Inc.

Thru: Mrs. RACHAEL P. CAFINO


School Dean
AMA Computer College – Dumaguete Inc.

This is to certify that I am waiving any claims against AMA COMPUTER COLLEGE –
DUMAGUETE INC. located at 2F UYMATIAO BLDG., COR. SAN JOSE & PERDICES STS.,
DUMAGUETE CITY, NEGROS ORIENTAL and/or its representative from any liabilities arising
from any injury that maybe sustained during the on-the-job training of my son/daughter
______________________________________at _________________________________________
(name of student) (complete name of agency)
located at ________________________________________________________________________
(complete address of agency)
starting from ______________________________ to ______________________________________
(date started training) (completion date)
until student completes the stated Work Immersion hours to be completed within the stated start date
of training to completion date as a partial requirement for the ACADEMIC track wherein said student
is officially enrolled.

With our consent and Approval.

_____________________________________ Date Signed: _________________


Printed Name & Signature of Parent/Guardian

Noted by:

____________________________________ ____________________________________
Mr. FREDLIE P. BUCOG Mrs. RACHAEL P. CAFINO
Work Immersion Coordinator School Dean
AMA Computer College – Dumaguete Inc. AMA Computer College – Dumaguete Inc.

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