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College of Nursing: Waiver

This document is a waiver signed by a parent or guardian allowing their son/daughter to participate in related learning experience activities as part of the College of Nursing at Central Mindanao University. The waiver absolves the university and any affiliated organizations of liability for any injuries that may occur during travel, clinical duties, community exposure activities, or other learning experiences from circumstances beyond human control. The activities will take place from the second semester of the 2018-2019 academic year in various locations including hospitals, community areas, and industrial sites. The parent signs to acknowledge the waiver of their rights under the law.

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Cyril Jane Caanyagan Acut
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159 views2 pages

College of Nursing: Waiver

This document is a waiver signed by a parent or guardian allowing their son/daughter to participate in related learning experience activities as part of the College of Nursing at Central Mindanao University. The waiver absolves the university and any affiliated organizations of liability for any injuries that may occur during travel, clinical duties, community exposure activities, or other learning experiences from circumstances beyond human control. The activities will take place from the second semester of the 2018-2019 academic year in various locations including hospitals, community areas, and industrial sites. The parent signs to acknowledge the waiver of their rights under the law.

Uploaded by

Cyril Jane Caanyagan Acut
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
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COLLEGE OF NURSING

WAIVER

I, parent/guardian of ,
(Parent’s / Guardian’s Name) (Student’s Name)
of the College of Nursing and a resident of
do hereby waive my rights I have under Law for any injury that my son/daughter would suffer or incur
under circumstances beyond human control during the Related Learning Experience Activities
(Activity)
including travel to assigned areas including PNSA week on 2nd Semester AY 2018-2019.
(Activity) (Schedule Date)
Related Learning Experience Activities such as completion of Extension Duties at Base/Affiliating
Hospital (Bukidnon Provincial Hospital – Maramag) assigned Community Area for Community
exposure /services, Adventist Medical Center Valencia in shifting duty AM/PM/NOC, Busco Sugar
Milling Corporation, Inc. for Industrial Nursing, School Nursing & Birthing Home/OPT/TB DOTS in
Rural Health Unit - Maramag and other areas where conduct of nursing activity will be held.
( Related Learning Experience Activities and Place of Destination)

I hereby further absolve the Central Mindanao University and the admitting firm of whatever liability he/she
will encounter under the inclusive dates of the Orientation, Patient Assessment, Clinical Duty,
(Activity)
Community Exposure and other Related Learning Experience Activities.
(Activity)

Parent’s / Guardian’s Signature

Date:

Witness: NOTARY
PUBLIC

Doc. No. _______:


MAE DAYANNE M. SOLIVEN, RN, CRN, MSN Page No. _______:
Faculty In-charge Book No. _______:
Series of _______.

Noted:

PILAR V. DOMAGSANG, MAN, RN


Dean

SUBSCRIBED AND SWORN to before me this _____ day of _______________, _________ at Musuan, Maramag, Bukidnon, affiant
exhibiting to me his Community Tax Certificate/ identification card indicated below his name.

CMU-F-1-ACA-016 01 June 2015 Rev. 0

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