College of Agriculture

Xavier University
Cagayan de Oro City

PRACTICUM PROGRAM

WAIVER

This WAIVER is in connection with the Practicum program that Xavier University
has requested and which you have accepted and confirmed. The student-trainee
acknowledges that the permission granted by:

DEPARTMENT OF SCIENCE AND TECHNOLOGY

Regional Office -10, Carmen, Cagayan de Oro City

is made subject to the condition, which he/she hereby accepts and agree to, that
the company/firm will not assume any responsibility whatsoever for any injury or
accident which may happen to him/her within or outside the premises nor will the
company pay him/her any salary during the six-week period of the said program.
It is understood that there is no employer-employee relationship between the
office and the student.

I hereby certify that I have read this document before signing it and I have
completely understood the meaning and importance of the above waiver; that
the waiver hereby given by me is made willingly and voluntarily with full
knowledge of my rights under the law.

This WAIVER will be in effect for the duration of the Practicum Program
scheduled from April to May, ______.

Done this _____ day of _________, 2010 in the City of Cagayan de Oro.

_____________________________ ____________________________
CHERRY MAE S. LOMONGO LEOLINDA S. SAAB
Printed Name & Signature of Student Printed Name & Signature of Parent/Guardian

WITNESS
___________________________ _____________________________
JOSIE LASTIMOSA – IGLORIA ALFONSO P. ALAMBAN, CESO IV
Printed Name & Signature of Regional Director
School Representative