Document No.

:
FM-RES03-00-01
STUDENT AGREEMENT AND
LIABILITY WAIVER FORM
Effective Date:
January 04, 2018

Name:
Student Number: Gender:
School: Mapua University SHS Strand:
Contact No: Email Address:

I do hereby voluntarily undergo a research immersion program under the following terms and
conditions:

a. That the total no. of hours required of/for me to complete my research immersion program is
at least 80 hours (24 hours for Immersion Proper);

b. That I shall abide by the laboratories’ rules and regulations and comply with those imposed for the
research immersion program, otherwise I shall be excluded from further participation;

c. That, in the course of my research immersion program, I may have access to information which
may be of a confidential nature and proprietary to the laboratory, for which I may be required to
execute a confidentiality and non-disclosure agreement as a pre-requisite to my participation in
the said program;

d. That the time I will spend on the training program will not and should not be interpreted or
construed as working hours and should be regarded as non-compensable;

e. That I shall personally be made answerable for any and all liabilities for damage to property or
injury to third person, which may be occasioned by my intentional or negligent acts during the
course of my research immersion program;

f. That in addition to my liability under section (b), I may be subjected to further disciplinary action
in accordance with the school’s student manual.

g. That I have read this document and understand the responsibilities associated with participating
in the research immersion program.

WITH OUR CONSENT:

____________________ ____________________
STUDENT TRAINEE PARENT/GUARDIAN
Signature over printed name Signature over printed name

APPROVALS:

____________________
RES03 Teacher
Signature over printed name

____________________ ____________________
Principal ILMO Director
Signature over printed name Signature over printed name