Republic of the Philippines

Department of Education
Region V
Schools Division of Sorsogon
PILAR NATIONAL COMPREHENSIVE HIGH SCHOOL
Marifosque, Pilar, Sorsogon

TRAINING AGREEMENT AND LIABILITY WAIVER

I, _________________________________________________ a student of Pilar National
Comprehensive High School hereby voluntarily agree to undergo immersion at
_____________________________ as required for graduation of the track TECHNICAL
VOCATIONAL –LIVELIHOOD (TVL) TRACK/COMPUTER SYSTEMS SERVICING (CSS)
NC II under the following terms and condition.

1. That I shall abide by the rule and regulations of the agency and shall comply
with those imposed for the program, otherwise, I shall be excluded from further
participation.
2. That there is no Labor Management relation between me and the
__________________________________.
3. That I shall answer liabilities for damages to properly or injury to the third person
that might result from intentional or negligent acts while the course of the
immersion and after due process.

Signed this ____________ day of ______________________, 2018 at

_________________________________________ Philippines.

________________________________
Signature of Student
Res.Cert. No.:
___________________
Issued at
________________________
Issued on
_______________________

With our consent and approval:

_______________________________________ ____ELENOR M. OBLIGAR____

Parent/Guardian (Signature over printed name) Principal II

Res. Cert. No.: _________________________ Res. Cert. No.:

_______________
Issued at: _____________________________ Issued at:
___________________
Issued on: ____________________________ Issued on: __________________

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Witnesses:

OSCAR M. MIRANDA MARIFE D. CANTORIA

Immersion Teacher SHS Coordinator

RIUS SHERYL P. CARILLO ELENOR M. OBLIGAR

School Partnerships Focal Person Principal II

SUBSCRIBED AND SWORN TO ME this _________________ day of

_________________________ 2017 at ___________________________________________ Philippines.

_________________________________
Notary Public

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 Republic of the Philippines
Department of Education
Region V
Schools Division of Sorsogon
PILAR NATIONAL COMPREHENSIVE HIGH SCHOOL
Marifosque, Pilar, Sorsogon

PARENT/GUARDIAN CONSENT FORM

A. PARENT OR GUARDIAN INFORMATION

Given name/s :
__________________________________________________________
Family name : __________________________________________________________
Relationship to child :
__________________________________________________________
Address : __________________________________________________________
Contact Number : __________________________________________________________

Does your child suffer from any medical condition/allergies that the teacher should
be aware of (including any current medication):
__________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Please provide details of medication that must be administered:

___________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

B. EMERGENCY CONTACT PERSON/S

Please provide details of another person who may be contacted by the child or by
the immersion teacher/institution supervisor if the parent/guardian cannot be
contacted.
Name of contact person : __________________________________________________
Address : __________________________________________________
Contact Number : __________________________________________________

C. STUDENT INFORMATION

Given Name/s : __________________________________________________

Family Name : __________________________________________________
Date of Birth : __________________________________________________
Year Level at School :
__________________________________________________
Address : __________________________________________________
Contact Number : __________________________________________________

D. PARTNER INSTITUTION DETAILS

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 Name of Agency/institution :
__________________________________________________
Address : __________________________________________________
Description of employment offered :
_________________________________________________

E. PARENT’S CONSENT AND WAIVER (PLEASE READ CAREFULLY)

In consideration of the consent given for the participation in the work immersion, I,
or my child’s authorized guardian, together with my child, do hereby release and waive
Pilar National Comprehensive High School, its officers, faculty, staff and representatives,
from any and all claims should any damage be caused or liability be incurred to property
or person arising from, but not limited to, participation in the said activity.

I expect and know that the school will exercise the diligence required for the safety
and well-being of my child and that his/her participation in the activity will be beneficial to
him/her. However, participation in the activity carries with it certain risks that cannot be
eliminated regardless of the care taken to avoid injuries. I know and understand these and
other risks that are inherent to the stated activity and I hereby assert that my child’s
participation, as well as my consent to it, is voluntary and that I knowingly assume all such
risks. However, should anything happen that harms my child, I expect to be notified
immediately through my contact number as stated above.
I acknowledge that I am signing this freely and voluntarily, and intend this by my
signature to be a complete and unconditional release of all liability to the greater extent
allowed by law.

______________________________ ______________________________
Signature Over Printed Name of Signature Over Printed Name of
Parent/Guardian Student

___________________ ___________________
Date Date