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Page 1: 6 - Parent's Waiver Form

7/16/2019 6 - Parent's Waiver Form

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DE LA SALLE UNIVERSITY

Psychology Department240 Ta!t A"en#e$ %an&la

PARENT'S (ERTI)I(ATI*N *) +AIVER )*R PSY(,*L*-Y PRA(TI(U%

  Term 1, 2015-2016

To whom this may concern:

This is to certify that I am allowing my daughter, Marizza eyes, to do !racticum wor" at #hili!!ine

$eneral %os!ital, one of the !racticum sites a!!ro&ed 'y the #sychology (e!artment starting on the 1stTerm, 201)-2015*

It is understood that +he will a'ide 'y the rules and regulations set 'y the !racticum facultycoordinator, who is tas"ed with closely monitoring the !racticumers !rogress*

hile I ha&e 'een assured that !re&ious !racticumers assigned to &arious sites ha&e safelycom!leted their assigned tas"s, I fully agree to wai&e any res!onsi'ility on the !art of (e .a /alleni&ersity and the !sychology de!artments faculty coordinator, in case of any untoward incident that mayha!!en to my daughter in the course of fulfilling the reuirements for !racticum*

  Marizza eyes    #rinted 3ame of /tudent /tudents /ignature+(ate

  4liza'eth eyes    #rinted 3ame of #arent #arents /ignature+(ate

 Maria ndrea /* Tirazona, M*/*    #rinted 3ame of aculty 7oordinator aculty 7oordinators /ignature+(ate

38T4( 9:

    (r* .aurene 7hua-$arcia  7hair, #sychology (e!artment


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