WAIVER FORM

I, Arlyn B. Bruce, hereby give my full consent for my son/daughter, Angeline B. Bruce,
to complete the remaining number of hours required for his/her OJT program at
Nutrition and Dietetics Department, Veterans Memorial Medical Center.

I understand that Angeline B. Bruce is currently enrolled in a Hospital Dietetics

Practicum course that includes practical training at your esteemed institution. Due to
unforeseen circumstances, Angeline B. Bruce has some outstanding hours that need
to be fulfilled to complete the required training successfully. I understand that
completion of the full on-the-job training (OJT) is not only necessary for the clearance
process but also crucial for my child to gain the practical experience and skills
required for their chosen field.

We execute this Consent Form in accordance with our free will, realizing the benefits
that the student intern shall obtain from the said OJT program.

Name and Signature of Name and Signature of

Student Intern Parent/Guardian

REPUBLIC OF THE PHILIPPINES

CITY OF __________________ ) S.S

Subscribed and sworn to before me, this ____________________________________ at

___________________________, Philippines, affiants exhibiting valid proofs of their
identity as follows:

Name ID No. Issued at/on

They acknowledge to me that the foregoing Consent Letter Form was executed in
accordance with their own free will.

Doc. No. ____

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