GOLDENSTATE COLLEGE

Pioneer Avenue – P. Acharon Blvd.

General Santos City
Telefax (083) 552-5544
www.goldenstate.edu.ph

IN-PLANT TRAINING WAIVER OF CLAIM

TO ALL WHOM THIS MAY CONCERN:

Parent Name Student Name

This is to certify that I,_____________________________parent/guardian of
____________________________, student of Goldenstate College, General Santos City applied for On-the-Job Training
at _________________________, , from________________ 2024 to __________________, 2024 with the total number
of 1,000 hours.

I understand and agree that the training is necessary as well as important in the implementation and partial
completion of the Bachelor of Science in Social Work course based on CHED Memorandum Order: 39 s. 2017 and R.A
4373 sec. 12 (e).

Student Name
I affirm that the _________________________ is not in any way responsible nor shall pay compensation for any
accident, harm or injury that may cause on said student while at the said plant or firm.

I also certify that he/she has on his/her own free will signified his/her decision to undergo this On-the-Job
Training is evidence by his signature affixes below together with my own signature.

I further affirm that the said student trainee shall be held responsible for whatever damages will be done during
his/her On-the-Job Training.

______________________ _______________________ ALBERT S. ALGABRE, RSW

Parent/Guardian Student Program Coordinator

Date signed:______________ Date signed:______________ Date

signed:______________
CTC/ID No.:______________ CTC/ID No.:______________ ID No.:______________

Issued at :________________ Issued at :________________ Issued at :______________

On _____________________ On _____________________ Valid until_______________

Republic of the Philippines )

City of General Santos

SUBSCRIBED AND SWORN to before me this ____ day of __________________ 20___, in the City
of General Santos City, Philippines.

Doc No.:__________;
Page No: __________;
Notary Public
 GOLDENSTATE COLLEGE
Pioneer Avenue – P. Acharon Blvd.
General Santos City
Telefax (083) 552-5544
www.goldenstate.edu.ph

Book No.: __________;

Series of 20 ________.