WORK IMMERSION WAIVER

____________________________

Date

___________________________
___________________________
___________________________

Dear Sir/Madam:

We would like to inform you that permission is hereby granted to our son/daughter
___________________________ to participate in the Work Immersion that is a requirement in the TVL
Track _____________________. We understand that the sail skills training will cover 80 training hours,
which will be conducted in __________________________________________, located at
____________________________, from _________________, 2017 until __________________, 2018.

We are aware that the Teacher-In-Charge of the Work Immersion will conduct visitation and
monitor the performance of the student, and that the immediate superior within the company will take
all the necessary precautions to keep the student safe.

However, if despite all efforts taken, untoward incidents beyond their control occur, we will not
hold Lubang Vocational High School and the ________________________ where our son/daughter took
the Work Immersion liable.

_______________________________
Parent / Guardian
Signature Over Printed Name

_______________________________
Date
 PARENTAL CONSENT AND WAIVER FORM
I, __________________________, grant permission for my son/daughter, _______________________, to
participate in the Work Immersion at ______________________ from __________________, 2017 to
_________________________2018, which requires transportation to a location away from the university
site. This activity will take place under the guidance and direction of Company Supervisor and Work
Immersion Teacher-In-Charge.

I, as parent and/or legal guardian, remain legally responsible for any personal actions taken by the above
named participant. I agree on behalf of myself, my child named herein, or our heirs, successors and
assigns, to hold harmless and defend Lubang Vocational High School and
______________________________ , its employees, faculty, or representatives associated with the
event, from any and all actions, claims, demands, damages, costs, expenses and all consequential damage
arising from or in connection with my child participating the Work Immersion or in connection with any
illness or injury or cost of medical treatment in connection therewith. In signing the Parental Consent and
Waiver, I am not relying on any oral or written representation or statements made by the school and the
company, its employees, faculty, or representatives associated with the programother than those set out
in this Consent and Waiver. I am 18 years of age or more and have read and understand the terms of this
consent and waiver, and recognize that it is binding upon me, my heirs, executors and administrators.

_______________________________ __________________________
Parent/Guardian over Printed Name Date

Home Address: ____________________

Contact No(s): ____________________
 DEPARTMENT OF EDUCATION
Region IV-MIMAROPA
Division of Occidental Mindoro
LUBANG VOCATIONAL HIGH SCHOOL
Tangal Lubang, Occidental Mindoro, 5109

ACTIVITY CONSENT AND PARENT’S/GUARDIAN’S PERMIT

The undersigned parent/guardian of __________________ hereby voluntarily and willingly allow

and permit him/her to join the Boy Scout of the Philippines Investiture at Lubang Vocational Quadrangle
on January 15, 2018 and the Institutional Camping and Team Building on January 19-20, 2018 at LVHS
Campus.
I understand that participation in Scouting activities involves a certain degree of risk and can be
physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have
given consent for myself or my child to participate in this activity. I also understand that participation in
this activity is entirely voluntary and requires participants to abide by applicable rules and regulations and
standards of conduct. I release the Boy Scouts of the Philippines, the Local Council, the activity
coordinators, and all Professional Staff, Volunteers, related parties, or other organizations associated with
the activity from any and all claims or liability arising out of this participation.

In witness thereof, I have here unto set my hands this _____ day of January, in the year 2017.

________________________
Parent/Guardian
(Signature over printed name)

_________________________
Date

CERTIFICATION

I hereby certify that my parent/guardian has given conformity to my joining the Boy Scout of the
Philippines Investiture at Lubang Vocational Quadrangle on January 15, 2018 and the Institutional
Camping and Team Building on January 19-20, 2018 at LVHS Campus.

________________________
Student
(Signature over printed name)

Noted:
______________________
ALFREDO S. PULI JR.
School Principal III