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Code: SLSU-OF-IN07
Revision: 00
Date: 20 October 2015

Republic of the Philippines

SOUTHERN LEYTE STATE UNIVERSITY
COLLEGE OF TEACHER EDUCATION
San Isidro, Tomas Oppus, Southern Leyte

OFFICE OF THE OJT COORDINATOR

Department

1.1 PARENTS’ CONSENT

I/We, Mr. and Mrs.

parents of , a prospective On-the-job trainee of the Southern
Leyte State University – College of Teacher Education have hereunto
grant permission for him/her to undergo hours of the On-the-Job Training (OJT) in
(industry) which is a requirement for graduation.

That we made it known our continued financial and moral support to him/her during
the training. That we shall adhere to any disciplinary action of the school, such as dropping
him/her from the rolls of trainers and/or barring him/her from graduation should it be found
that he/she is a frequent absentee and/or notoriously undesirable trainee.

1.2 WAIVER

THIS IS TO CERTIFY that Southern Leyte State University – College of Teacher Education
and the are no way responsible nor shall pay compensation for
any accident, harm or injury that may be caused on our son/daughter during the training,
unless al precautionary measures are being implemented to prevent any accident to happen.

It is fully known that we have read and understood al the contents of the parents’
consent and waiver and have signed the same with our voluntary act and deed.

Signed this day of 20 in , Philippines.

Signature of Parent/Guardian Signature of Student – Trainee

WITNESSES:

OJT Coordinator/Faculty OJT Adviser/Academic Adviser

NOTED: CONFORME:

Associate Dean for Instruction Signature over Printed Name of Student-Trainee

SUBSCRIBED AND SWORN TO before me this day of , 20 at

, Philippines.
Notary Public