PARENT’S CONSENT
I / We, Mr. & Mrs._________________(NAME OF GUARDIAN)______________________
parents /guardian of_____________(NAME OF STUDENT_______________, a prospective
Student-Trainee of University of the Visayas – Dalaguete Campus, have hereunto grant
permission for my son / daughter to undergo FIVE HUNDRED HOURS (500 hours)
Teaching Internship in _______(COOPERATING SCHOOL)______ which is the requirement
for the completion of the course, Academic Year 2024-2025, Second Semester.
That we made it known our continued financial and moral support to our son/daughter.
That we shall adhere to any disciplinary action of the school, such as dropping him/her
from the rolls of trainees and /or barring him/her from graduation should be found that
he/she is frequent absentee and/or notoriously undesirable trainee.
________________________
Signature of Parents | Guardian
WAIVER
Thus, THIS IS TO CERTIFY that the UNIVERSITY OF THE VISAYAS- DALAGUETE
CAMPUS-College of Education and the __ (COOPERATING SCHOOL)______________are in
no way responsible nor shall pay compensation for any accident, harm or injury that may
be cause on our son/daughter during the training, provided all precautionary and
preventive measures are in place and being implemented to prevent any accident
happen. It is fully known that we have read and understood all the contents of this waiver
and have signed the same with our voluntary act and deed.
Signed this __________ day of ____________ 2024 in _________________, Philippines.
WITNESS:
JAYVIE BRYLE C. CAMILO, LPT ANGELICA B. REDULA, LPT
Practicum Coordinator-College of Education Program Coordinator- College of Education
NOTED:
PRISCILA S. MANSUETO, LPT, DM.
Dean, College of Education
CONFORME
________________________
Signature of the Student Intern
SUBSCRIBED AND SWORN to before me this ____day of _____2024, at__________, Philippines,
Affiant/s personally appeared and exhibited to me his/her/their competent proof/s of identity
____________________________.
Doc No.___;
Book No.__;
Page No.__;
Series of 2024.
