ANNEX F

Republic of the Philippines

Department of Education
Region 02/ Cagayan Valley
Division of Isabela
BACNOR NATIONAL HIGH SCHOOL
Bacnor West, Burgos, Isabela

Parents’ / Guardian’s Certification of Waiver / Permission

This is to certify that I am allowing my child______________________________

to go on a Work immersion for at least 80 hours starting on__________________
to________________ at ______________________________________________

It is understood that he/she abides by the rules and regulations that may be
imposed by the Supervisor/Staff-in-Charge for his/her welfare and safety. I fully
agree to waive any responsibility on the part of the Department of Education,
Schools Division of Isabela, Bacnor National High School and/or the
representative/s, in case of any untoward incident that may happen to my child
during the duration of the Work Immersion.

________________________________ ________________________________
Signature of Parents Over Printed Name Signature of Parents Over Printed Name
Date: ________________________ Date: ________________________