CONSENT & WAIVER

Know All Men By These Presents:

In consideration of my/our son/daughter/ward (Name of Student-

Trainee) undergoing an on-the-job-training program with (Company Name) in
partial compliance to the curriculum requirements of the University of San
Carlos, I/We (Name of Parents/Guardians), Filipino(s), of legal age(s), and
resident(s) of ______________________________________, agree to RENOUNCE and
WAIVE any and all claims that I/we may have against and RELEASE from
liability the (COMPANY NAME) and the UNIVERSITY OF SAN CARLOS, their
directors, officers, stockholders, employees, agents or representatives for any
injury, loss or damage that my son/daughter/ward might sustain as a result of
or in connection with or arising through his/her fault or negligence while in the
course of participating in the (Company Name) on-the-job training program.

We hereby give consent and acknowledge by our signatures as affixed

herein that:

1. (Name of Student-Trainee) is physically fit to participate in the on-

the-job training program;
2. I/we assume full responsibility for (Name of Student-Trainee) for
injury, loss or damage that he/she may incur/commit while in the
course of the on-the-job training program;
3. I/we agree to indemnify (Company) for loss or damage to its property
attributable to the fault or negligence of (Name of Student-Trainee);
4. I/we hold free and harmless the (Company) and the University of San
Carlos from any accident, negligence, loss or damage while under
training.

IN WITNESS WHEREOF, I/we have hereunto affixed my/our signature

this __ day of ___________ 2015 in the Municipality/City of _______________,
Philippines after having fully read and understood the contents as well as the
legal repercussions of this Consent and Waiver.

_________________________________________________
(Signature over printed name of Parents/Guardian)
ID No.___________________
Issued by:_______________
Issued on_______________

_________________________________________________
(Signature over printed name of Parents/Guardian)
ID No.___________________
Issued by:_______________
Issued on_______________

_________________________________________________
(Signature over printed name of Student-trainee)
ID No.___________________
Issued by:_______________
Issued on_______________
_________________________________________________
(Signature over printed name of Witness)
ID No.___________________
Issued by:_______________
Issued on_______________

_________________________________________________
(Signature over printed name of Witness)
ID No.___________________
Issued by:_______________
Issued on_______________

Republic of the Philippines)

City of Cebu )

ACKNOWLEDGMENT

Before me this __ day of _____ April 2015 in the City of Cebu, Philippines
personally appeared the abovenamed person with his/her competent evidence
of identity with the details shown below his/her name as above-indicated
known to me to be the same persons who executed the foregoing Consent &
Waiver they acknowledged before me that the same is of their own free
voluntary act and deed.

Doc No.___;
Page No.__;
Book No.__;
Series of 2015.