WAIVER/UNDERTAKING 

 
 
We,  (student-trainee)   
(parent/  guardian),  hereby  execute  this  Waiver/  Undertaking  to  hold  the  Polytechnic 
University  of  the  Philippines  and  the  training  institution  free from any liability for any injury / 
illness  /  loss  of  life  or  property  that  may  be  incurred/  sustained  by  the  student-trainee  in  the 
course  of  his/  her  on-the-job-training  /  practicum  with  the  training  institution  provided  that 
the  same  is  not  due  to  any  willfull  criminal  act  or  gross negligence of the training institution or 
any of its representatives, officers or employees. 
 
As  the  parent/  guardian  of  the  student-trainee,  I  hold  myself responsible for any expenses that 
may  be  incurred  as  a  result  of  the  student’s  illness,  injury,  death  or  loss  or  property  in  the 
course  of  the  student’s  on-the-job  training/  practicum,  except  as  provided  above.  I  further 
undertake  to  be  responsible  for  any  breakage,  loss  of  property,  damage,  death  or  injury  that 
may be caused by the student-trainee to any party while undergoing training. 
 
We  execute  this  Waiver/  Undertaking  in  accordance  with  our  free  will,  realizing  the  benefits 
that the student-trainee shall obtain from the said on-the-job training / practicum. 
 
 
 
 
 
(Printed Name and Signature of (Printed Name and Signature of 
Student-Trainee) Parent/ Guardian) 
 
 

REPUBLIC OF THE PHILIPPINES ) 

CITY OF  ) 
 
 
​Subscribed and sworn to before me affiants exhibiting valid proofs of their identity as  
follows: 
 
Name  ID No.  Issued at/on 
     
_________________________  __________________  ____________________________________ 
     
_________________________  __________________  ____________________________________ 
 
They  acknowledged  to  me  that  the  foregoing  Waiver/  Undertaking  was  executed  in 
accordance with their own free will. 
 

NOTARY PUBLIC 

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