Parents’ / Guardian’s Certification of Waiver / Permission

TO WHOM IT MAY CONCERN:

This is to certify that I, Mr./Mrs. _________________________ parent/guardian of ______________________. A

Bonafede student at VANS PRIVATE TECHNICAL SCHOOL INCORPORATED, granted him/her the permission
to undergo industry work immersion for a minimum of ____________ hours starting on ____________ until
____________ at ________________________________ in partial fulfillment of the requirements for the Senior
High School.

It is understood that he/she abides by the rules and regulations that may be imposed by the Work Immersion
Teacher and Industry Supervisor for his welfare and safety.

I fully agree to waive any responsibility on the part of VANS PRIVATE TECHNICAL SCHOOL INCORPORATED
and the COMPANY NAME/FIRM, and its representative/s, in case of any untoward incident that may happen to
my son/daughter during the duration of the Work Immersion Program.

________________________________________ ________________________________
NAME AND SIGNATURE OF PARENT/GURDIAN NAME AND SIGNATURE OF STUDENT

________________________________________ ________________________________
PARENT ADDRESS CONTACT NUMBER

SUBSCRIBED AND SWORN to before me this ___________________ say of _______________, 20____ At

_______________________, Philippines, affiant exhibited to me his/her Community Tax Certification No.
___________________, issued on _________________________ at
__________________________________________, Philippines.

Doc No. _______

Page No. ______
Book No. ______
Series of 20 ____