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    Waiver 1

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    kasjdkas
    This document is a waiver and release form for students in the College of Nursing to participate in related learning experiences as part of their curriculum. It requires signatures from the student, their parent or guardian if they are a minor, clinical instructors, various program chairs, the academic dean, and a notary. By signing, all parties agree to waive any legal claims against the University if the student is injured during their participation in skills demonstrations, return demonstrations, simulated community health experiences, or hospital duties. Students also agree to follow safety precautions and rules set by the University and organizing committee.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Waiver 1

    Uploaded by

    kasjdkas
    8 views1 page
    This document is a waiver and release form for students in the College of Nursing to participate in related learning experiences as part of their curriculum. It requires signatures from the student, their parent or guardian if they are a minor, clinical instructors, various program chairs, the academic dean, and a notary. By signing, all parties agree to waive any legal claims against the University if the student is injured during their participation in skills demonstrations, return demonstrations, simulated community health experiences, or hospital duties. Students also agree to follow safety precautions and rules set by the University and organizing committee.

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    waiver-1

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    This document is a waiver and release form for students in the College of Nursing to participate in related learning experiences as part of their curriculum. It requires signatures from the student, their parent or guardian if they are a minor, clinical instructors, various program chairs, the academic dean, and a notary. By signing, all parties agree to waive any legal claims against the University if the student is injured during their participation in skills demonstrations, return demonstrations, simulated community health experiences, or hospital duties. Students also agree to follow safety precautions and rules set by the University and organizing committee.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views1 page

    Waiver 1

    Uploaded by

    kasjdkas
    This document is a waiver and release form for students in the College of Nursing to participate in related learning experiences as part of their curriculum. It requires signatures from the student, their parent or guardian if they are a minor, clinical instructors, various program chairs, the academic dean, and a notary. By signing, all parties agree to waive any legal claims against the University if the student is injured during their participation in skills demonstrations, return demonstrations, simulated community health experiences, or hospital duties. Students also agree to follow safety precautions and rules set by the University and organizing committee.

    Copyright:

    © All Rights Reserved
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    COLLEGE OF NURSING

    WAIVER AND RELEASE FOR RELATED LEARNING EXPERIENCE


    (Limited Face-to-Face RLE)

    Academic Year ; 20____-20____ ;  1ST Sem ;  2nd Sem

    We/I, ___________________________________have given ________________________permission to attend the


    limited Face-to-Face Related Learning Experience in Skills demonstration and Return demonstration, simulated
    community health nursing and hospital duty as stipulated in the Joint Memorandum Circular#2021-001 and which
    is a part of the curriculum as per CHED Memorandum Order No. 15 series of 2017. We are aware of the risks that
    our son/daughter may be exposed to during these Related Learning activities. Just the same, we allow him/her
    without any reservation to participate in these Related Learning activities for the duration of his/her course. While
    he is participating in the said learning activities, we hereby voluntarily and expressly waive any or all actions,
    claims, or demands against University of the Cordilleras, its trustees, officers, teachers and/or employees should
    our son/daughter suffer any injury or damages which may happen beyond the control of the faculty; and we
    hold harmless the said University of the Cordilleras, its trustees, officers, teachers, and/or employees from any such
    action, claim or demand.

    Similarly, I, _____________________________________________, hereby voluntarily and expressly waive any or


    all actions, claims or demands against University of the Cordilleras, its trustees, officers, teachers, and/or
    employees should I suffer any injury or damages while I am participating in the said Related Learning activities:
    and I hold harmless the said University of the Cordilleras, its trustees, officers, teachers and/or employees from
    any such action, claim or demand, provided however, that utmost care, attention and precautions are
    undertaken and/or exercised by those concerned.

    I shall observe diligence to ensure myself and well-being.

    I shall comply with rules and regulations set by the University and the organizing committee.

    Signed this _____day of _________________________.

    STUDENT (Name I Signature I Date) PARENT/GUARDIAN (Name I Signature I Date)

    Contact Nos.: Contact Nos.:

    Relationship with the Student:

    SUBSCRIBED AND SWORN to before me in the City of Baguio, Philippines, this __th day of ___________,
    _____, by _____________________ and _______________, with ID No. ___________________________, who are the same
    persons who personally signed before me the foregoing RWQ and acknowledged that they executed the same.

    Doc. No. _____;


    Page No. _____;
    Book No. _____;
    Series of ______.

    NOTED:

    Clinical Instructor (Name I Signature I Date) Program Chair, CIR (Name I Signature I Date)

    Program Chair, HNP (Name I Signature I Date) Program Chair, CHP-EOP (Name I Signature I Date)

    Academic Dean (Name I Signature I Date)

    UC-CON-FORM-221 Page 1 of 1
    Aug.2, 2021 Rev.01

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