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PLMun Field Study Waiver and Consent Form

The document is a waiver of rights form from the Pamantasan ng Lungsod ng Muntinlupa (PLMun) allowing student Krister Ann M. Jimenez to complete required off-campus observation hours for her degree program. The waiver stipulates that the student must abide by school rules, comply with programs, and will not hold PLMun or partner schools liable for any accidents or injuries during the placement. It also states the student is responsible for any property damage or injuries caused during the placement. The form is signed by the student and witnessed by faculty members.

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KRISTER ANN JIMENEZ
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25 views1 page

PLMun Field Study Waiver and Consent Form

The document is a waiver of rights form from the Pamantasan ng Lungsod ng Muntinlupa (PLMun) allowing student Krister Ann M. Jimenez to complete required off-campus observation hours for her degree program. The waiver stipulates that the student must abide by school rules, comply with programs, and will not hold PLMun or partner schools liable for any accidents or injuries during the placement. It also states the student is responsible for any property damage or injuries caused during the placement. The form is signed by the student and witnessed by faculty members.

Uploaded by

KRISTER ANN JIMENEZ
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

PAMANTASAN NG LUNGSOD NG MUNTINLUPA Doc.

Number
College of Teacher Education Effectivity 01 August 2019

WAIVER OF RIGHTS Approved by Dr. Danilo B. Solayao

The Pamantasan ng Lungsod ng Muntinlupa (PLMun) with postal address at Poblacion, Muntinlupa City hereby agrees to endorse
Krister Ann M. Jimenez
______________________________________ to undergo her required hours of off-campus observation at
_______________________________________ which is an academic requirements on his/her degree, under Field Study (FS)
course, with the following terms and conditions:

1. That he/she shall abide the school’s rules and requisitions and shall comply with those imposed for the programs; otherwise
he/she shall be excluded from further participation;

2. That PLMun and the school where he/she will be placed shall not in any way be held liable for any accident or injury that she
may suffer in the course of her obligation visit/practice teaching.

3. That he/she should be answerable in any and all liabilities for damage of property or injury to third persons, which may be
occasioned by her intentional or negligent acts while in the course of his/her training.

Signed this __ day of ____________, 2021 in Muntinlupa City. I hereby waive/renounce the right to any claims for compensation or
Marchand/or ____________________________ in any case of accident/injury during the Field Study.
9 against PLMun
course of action

__________________________________________
Krister
Signature overAnn M. Jimenez
Printed Name of Student
Witnesses:

Asst. Prof. Sannie A. Jusay, LPT Asst. Prof. Sannie A. Jusay, LPT
Faculty, Field Study Program Chair

PARENTAL CONSENT FORM

I, _________________________________, of legal age and a resident of ____________________________________________


JimmyPamantasan
Hereby authorize H. Jimenezng Lungsod ng Muntinlupa (PLMun) to send ___________________________ for Field. Study
Blk. 14 Lot 25 Celina Plains [Link] City (FS).
Krister Ann M. Jimenez
I, hereby waive/renounce the right to any complaint for compensation or course of action against PLMun and
______________________________ in any case of accident/injury in the course of the Field Study.

In this view, I hereby affixed my signature below this ___ day of ________________, 2021 at Muntinlupa City.
9 March
________________________
Jimmy H. Jimenez
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ___________, 2021 affiant exhibiting to me his/her government issued
Identification Card No. ____________ issued by ____________ with expiry date on ______________.

WITNESS MY HAND AND SEAL on the day first above written.


NOTARY PUBLIC:
Doc. No. _______;
Page No. _______;
Book No. _______;
Series 2021

Revision Date: March 4, 2021 Documents Distribution: 8 Copy No.: 01

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