(Form 4)

WAIVER
The College of ____________ of (Name of School), (City or District), has requested this waiver in connection with its On-The-Job Training (OJT) Program offered this __ Semester of SY _____ - _____ and which is accepted and confirmed. The student-trainee,

Complete Name,

Course and Year

together with his / her parents or judicially appointed guardian acknowledge that the permission granted to him is made subject to the condition, which he / she hereby accepts and agrees to, that the university will not assume any responsibility whatsoever for any injury or accident which may happen to him within or outside the premises of the project area during the period of said program. It is understood that there is no employer-employee relationship between the university and the student-participant. This waiver will be in effect for the duration of ________________ to ________________ (the duration of this Program). Done this _____ day of ________________ (Year), in the (City or District).

_______________________________ Signature of OJT Participant

__________________________________ Signature over Printed Name of Parent or Judicially Appointed Guardian

Witnessed:

_________________________ Dean, College of __________

_______________________________ Company/Agency/Bureau Representative

___________________________________ Name of Company/Agency/Bureau