Beruflich Dokumente
Kultur Dokumente
It is hereby acknowledge by the undersigned parents or legal guardian that they have
read, understand and voluntarily agreed to comply with the provisions of the internship
program of San Pedro College- ________________ Department as provided by the Clinical
Internship Manual and the stipulations enumerated herein.
1. PRE-INTERNSHIP CONDITIONS/REQUIREMENTS
Students shall strictly comply with the conditions and guidelines set by the San
Pedro College Student Handbook and MLS Internship Handbook. The same reference will used
for the students’ decorum and misconducts (See MLS-IP handbook page 14-19)
Students shall comply the additional conditions/requirements for those who will have
their internship outside Davao City. The following are the conditions & requirements:
The internship program will cover the period of November 19, 2018 to May 2019
or six (6) months and will be distributed randomly and accordingly to the different accredited
training institution.
_________________________ ________________________________
Name and Signature of Student Name and Signature of Parents/Legal Guardians
________________________________ _______________________________________
Aileen Grace L. Ang, RMT, MSBio, MSMT Juliie J. Tiu, RMT, MPH, MSMT
Clinical Internship Coordinator Department Dean
ACKNOWLEDGEMENT
BEFORE ME, a Notary Public for and in the City of Davao, Philippines, personally
appeared the above named parties with their individual competent evidence of identity
written below their names known to me to be same persons who executed the foregoing
instrument and they acknowledge that the same is their free and voluntary act.
That this Agreement, consisting of TWO (2) pages including this page whereon the
acknowledgement is written has been signed by the parties and their instrumental witnesses
on each and every page thereof.
WITNESS MY HAND AND SEAL this ___ day of _____________20__, at Davao City
Philippines.
Doc.No ____
Page No. ____
Book No. ____
Series of 20__
REPUBLIC OF THE PILIPPINES)
CITY OF DAVAO ) S.S.
x----------------------------------------x
3. THAT, in relation thereto I will be undergoing internship trainings to the following institutions for the
durations as listed;
4. THAT, I undertake to strictly and religiously follow the rules and regulations of the above listed
institutions during the duration of my internship program;
5. THAT, I voluntarily relieved the above listed institutions of any liabilities arising from any injury or
accidents that may arise during my internship at their institutions due to my fault or negligence;
6. THAT, the internship program is solely for compliance of my course curriculum and does not
establish any employer-employee relationship with them, nor I am entitled to any allowance or wages
nor they are not obligated to hire me afterwards;
7. THAT, this affidavit is executed in good faith without any purpose of defrauding anyone;
8. THAT, I am executing this affidavit to attest to the truth of the foregoing facts, and for whatever legal
purpose it may serve.