160 ML Tagarao St.

Brgy. Ibabang Iyam, Lucena City

373 -7130

AMA COMPUTER COLLEGE

SENIOR HIGH SCHOOL DEPARTMENT
PARENT/GUARDIAN/CAREER CONSENT FORM

Instruction: Please complete the following, sign and return toMs. Shierley Q. Olar for
approval.
Name of student: _______________________ Age:___________ ______

Name of Parent/Guardian: _________________________________ ____

Address: _____________________________________________ ____

Mobile: _____________________________________________ ____

Please provide details of medication that must be administered:

___________________________________________________________________

Emergency contact details: (If different from above)

Name: ____________________ Telephone: _______________________

Relationship to child: ____________________

CONSENT (please read carefully)

a) I agree to my son/ daughter taking part in the Field Work/Immersion in

partial fulfillment of the COURSE to develop the independent and critical
skills of the students.
b) I confirm to the best of my knowledge that my son/ daughter does not suffer
from any medical condition other than those listed above.
c) I fully support the work immersion undertaking of my son/daughter through
minimal financial cost and through my attendance/presence if so desired.
d) I consent to my son/ daughter travelling by any form of public transport,
minibus or motor vehicle by land or water in the course of gathering re-
search data.
e) I understand that the teacher/school accept no responsibility for any unto-
ward incident, damage or injury caused by or during attendance based on the
attached schedules of the field work/gathering data.

Issued this 15thday of November 2017.

CONFORME:

EDWIN J. LABAGUIS
Parent/Guardian

NOTED:

SHIERLEY Q. OLAR, LPT

SHS Work Immersion Coordinator
 160 ML Tagarao St.
Brgy. Ibabang Iyam, Lucena City
373 -7130

AMA COMPUTER COLLEGE LUCENA

SENIOR HIGH SCHOOL DEPARTMENT
Lucena City

DEED OF UNDERTAKING

Im, JIMWEL B. LABAGUIS, a Senior High School student from AMA Computer College herein referred to
as TRAINEE and I, Shierley Olar, Work Immersion Coordinator of the same school, do hereby declare, manifest
and undertake the following actions to wit;

THAT, the TRAINEE is bonafide student of AMA Computer College and of good moral character.

THAT, the above mentioned trainee shall undergo training with the MUNICIPALITY OF LUCENA CITY
where s/he would be assigned for 360 hours.

THAT, that we understand that this endeavour is a school requirement that should be completed before the end of
second semester of the academic year.

THAT, as TRAINEE, my work in the said office is voluntary on my part and I do not hold MUNICIPALITY
OF LUCENA CITY liable for any remuneration of any kind during the duration of training.

THAT, I will abide with all the office rules and regulations and I will maintain and keep confidentiality of all
information that I will hear, and read, during my training.

THAT, as a trainee I will be given a copy of performance evaluation and certificate of completion from the
MUNICIPALITY OF LUCENA CITY based on the criteria provided by the school.

AND THAT, we will hold the MUNICIPALITY OF LUCENA CITY FREE from ANY LIABILITY during the
duration of training.

Signed:

JIMWEL B. LABAGUIS
Trainee

Noted:

SHIERLEY Q. OLAR, LPT

AMACC SHS HEAD TEACHER