Republic of the Philippines

Department of Education
Region X
Division of Lanao del Norte
LANAO NORTE NATIONAL COMPREHENSIVE HIGH SCHOOL
Baroy, Lanao del Norte

PARENTS WAIVER
I, , of legal age, married/single and parent/guardian of
Name of Parent/Guardian

a student/trainee in
Name of student/trainee
for an in consideration of the opportunity of my son/daughter to undergo Work Immersion at

Name and Address of Company/Establishment/Shop Office/Agency

hereby stipulated the following conditions:
 That I have my wholehearted permission and support to go on Work Immersion.
 That I shall not bind or make responsible the school - Lanao Norte National Comprehensive High School neither
the Company/Establishment/Shop Office/Agency for anything that might occur or happen to my son/daughter
while on the period of the Work Immersion.
 That if ever my son/daughter will engage any of the crime violation (proven) within the training period, both
Company/Establishment/Shop Office/Agency and the Lanao Norte National Comprehensive High School will not
issue the following:
 Certificate of training
 Certificate of completion
 Evaluation Rating
 Transcript of Records

In witness hereof, I set my hand and affix my signature this ____ day of ___________, 2018 at
_____________________________________________, Philippines.

__________________________________________
Parent’s/Guardian’s Signature above Printed Name

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES

Province of Lanao del Norte ……………)S.S
BEFORE ME, a Notary Public for and in the ___________________________________, on
________________________ 2019, personally came and appeared with his/her Identification No.
_________________________________, known to me to be the same person who executed the foregoing instrument,
and he/she is acknowledged by me and his/her free act and deed.
IN WITNESS HEREOF, I have set my hand and affix my notarial seal, the day, year, and place written above.

Doc. No. ___________

Page No. ___________
Book No. ___________
Series of ___________.