EDUCATIONAL SYSTEMS TECHNOLOGICAL INSTITUTE

Murallon, Boac, Marinduque

WAIVER OF CLAIM AND ASSUMPTION OF RISK

In consideration of the permission granted to me to undergo Familiarization / Practical Training /

Basic Safety Training and Deck Watch keeping as part of the BS Marine Transportation program.

I AGREE AND ACKNOWLEDGE THAT:

1. I will abide by the rules, and regulations and instructions imposed on me during the said
training.

2. I understand that there are risks and hazards inherent to the nature of the training and
due to these risks, I acknowledge that I may suffer personal injury, as well as property
loss. The risks I may encounter may include but are not limited to burns, muscle strain,
falls, cuts, scraps, eye injuries, loss of body parts or even death. In lieu of those
mentioned risks, I will follow all safety instructions given and will wear personal protection
equipment issued to me by the supervisor.

3. I freely and voluntarily acknowledge and assume the aforementioned risks and hazards
and my participation in the training shall be entirely at my own risk.

4. I understand there is physical strength required to the training and I declare that I am
physically fit to undergo said training and manifested by the attached result of medical
examination.

5. This Waiver of Claim and Assumption of Risk Release is binding on myself, my heirs,
may executors, administrators, personal representatives and assignees.

6. I waive any claim against Educational Systems Technological Institute (ESTI) arising
from my training and agree to indemnify and hold harmless Educational Systems
Technological Institute (ESTI) for any claim, including any claim for medical services
arising from my participation in the said training due to my negligence.

_________________________________________
SIGNATURE OVER PRINTED NAME OF STUDENT

Date Signed_____________________

In consideration of the foregoing, I, the parent / guardian of _________________________

including my heirs and assigns, do hereby waive, renounce and repudiate all my rights and
claims appertaining thereto from any and all kinds of liabilities emanating from injuries, death, or
loss or damage to properties due to accident, caused by any fortuitous event or force majeure
while my child/sibling _______________________________ is on BASIC TRAINING.

IN WITNESS WHEREOF, I have here unto set my hand this _________ day of
_____________________, 2023- at ____________, Marinduque.

_______________________________
SIGNATURE OVER PRINETD NAME
PARENT/GUARDIAN

Date Signed___________________

SUBSCRIBED AND SWORN to before me this ______ day of ______ ________________at

___________________________.