AMA COMPUTER COLLEGE-DUMAGUETE INC.

2F Uymatiao Bldg., Cor. San Jose & Perdices Sts.,

Dumaguete City, Negros Oriental
SENIOR HIGH SCHOOL DEPARTMENT

WAIVER FORM

Mr. ROLANDO M. ROSALES

School Director
AMA Computer College – Dumaguete Inc.

Thru: Mrs. RACHAEL P. CAFINO

School Dean
AMA Computer College – Dumaguete Inc.

This is to certify that I am waiving any claims against AMA COMPUTER COLLEGE –
DUMAGUETE INC. located at 2F UYMATIAO BLDG., COR. SAN JOSE & PERDICES STS.,
DUMAGUETE CITY, NEGROS ORIENTAL and/or its representative from any liabilities arising
from any injury that maybe sustained during the on-the-job training of my son/daughter
______________________________________at _________________________________________
(name of student) (complete name of agency)
located at ________________________________________________________________________
(complete address of agency)
starting from ______________________________ to ______________________________________
(date started training) (completion date)
until student completes the stated Work Immersion hours to be completed within the stated start date
of training to completion date as a partial requirement for the ACADEMIC track wherein said student
is officially enrolled.

With our consent and Approval.

_____________________________________ Date Signed: _________________

Printed Name & Signature of Parent/Guardian

Noted by:

____________________________________ ____________________________________
Mr. FREDLIE P. BUCOG Mrs. RACHAEL P. CAFINO
Work Immersion Coordinator School Dean
AMA Computer College – Dumaguete Inc. AMA Computer College – Dumaguete Inc.