Scribd
Upload
141 views2 pages

Medical Background: Consent Form For Work Immersion

This consent form is for a student's participation in a work immersion program. It collects the student's name, date of birth, school, and contact information for their parent or guardian. The parent must indicate whether the student has any medical conditions or allergies and provide details of any necessary medication. The parent agrees to let the student participate, understands the school has insurance coverage, and confirms their awareness of any medical issues. The parent signs to acknowledge reading and understanding the form.

Uploaded by

AlbinMae Caroline Intong-Torres Bracero-Cuyos
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
141 views2 pages

Medical Background: Consent Form For Work Immersion

This consent form is for a student's participation in a work immersion program. It collects the student's name, date of birth, school, and contact information for their parent or guardian. The parent must indicate whether the student has any medical conditions or allergies and provide details of any necessary medication. The parent agrees to let the student participate, understands the school has insurance coverage, and confirms their awareness of any medical issues. The parent signs to acknowledge reading and understanding the form.

Uploaded by

AlbinMae Caroline Intong-Torres Bracero-Cuyos
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
You are on page 1/ 2

CONSENT FORM

for WORK IMMERSION

Name of Student:
Date of Birth:
School:
Name of Parent/Guardian:
Address:
Contact Number:

MEDICAL BACKGROUND

Does your child suffer from any medical conditions/allergies?


(Please check appropriate box)
YES NO
Please provide details of medication that must be administered, if any:

UNDERTAKING:
a) I agree to my son/daughter taking part in the work immersion as a key feature
of the Senior High School Curriculum, which involves hands on experience or
work simulation in which learners can apply their competencies and acquired
knowledge relevant to their track;
b) I understand and that an insurance for learners in DepEd schools shall be
procured by their respective schools, hence, I hereby release the school, its
teachers and personnel from any and all liability, clams, demands and causes
of action whatsoever arising out of or related to any loss, damage or injury that
may be sustained by my son/daughter during the Work Immersion;
c) I confirm to the best of my knowledge that my son/daughter does not suffer from
any medical condition other than those listed above;
d) That I have read and fully understood the statements above including the
implications thereof.

_______________________________________ Date:
Signature over Printed name of Parent/Guardian

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy