UNIVERSITY OF CALOOCAN CITY

Biglang Awa Corner, Cattleya Street, Caloocan City

COLLEGE OF BUSINESS and ACCOUNTANCY

CONSENT FORM for PRACTICUM/ INTERNSHIP

I, _____________________, parent/guardian of ________________________, _____ years

old, a 3rd year student of the UCC College of Business and Accountancy; In partial
fulfillment of the requirements for the degree BACHELOR OF SCIENCE in
ENTREPRENEURSHIP voluntarily agree that he/she shall be undergoing an
____________________________for ___________ starting on _____________ at
_____________________________________________ .

I hereby agree that my child needs to observe the following:

● Take responsibility in taking necessary precautions to avoid or get involved in any
incident that could cause loss, damage, or injury to his/her own self or that of
another;
● Be responsible to fully ascertain, if necessary, with the help of a medical
professional, his/her physical and mental fitness to join such activity;
● Be sufficiently healthy or free from any medical condition that may be exacerbated
or aggravated by his/her participation in such activity. Should he/she be suffering
from any medical condition, he/she should commit to immediately report the same
in writing to the assigned internship coordinator and excuse him/herself from the
said activity.
● Strictly observe the rules and regulation of the internship program and the
cooperating Training Establishment as stated in the Internship Plan.
● That any violation made is subject to appropriate disciplinary actions.

Furthermore, I hereby agree to waive any responsibility on the part of the University
of Caloocan City in relation to any untoward incident or any incident beyond their control
that may happen to my child during the said activities.

This AGREEMENT shall take effect immediately upon signing by all parties concerned
and shall remain in force on the duration of the field study/internship program.

IN WITNESS WHEREOF, parties of the agreement hereunto affix their signature

this _____ day of ___________ at Caloocan City, Philippines.

Parent / Guardian University of Caloocan City

By:

______________________________ DR. SHIRLEY V. SARAGCON

Signature over printed name/date Dean, College of Business & Accountancy

Signed in the Presence of:

SARAH JOY G. DOMINGO, MBA

Program Coordinator

1
 UNIVERSITY OF CALOOCAN CITY
Biglang Awa Corner, Cattleya Street, Caloocan City

COLLEGE OF BUSINESS and ACCOUNTANCY

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES

BEFORE ME, a Notary Public in ____________________, Metro Manila this

____________________ day of ______________ 2022, personally appeared
_____________________ and ________________________ with their identity documents/
cards, known to me and to me that the same is their free act and deed.

This instrument, consisting of two (2) pages, including the page on which this
acknowledgement is written, has been signed by the parties and their witnesses, sealed
with my notarial seal.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal on
the day, year and place first above-written.

Doc. No. __________

Page No. __________
Book No. __________
Series of 2022