University of Southeastern Philippines COLLEGE OF ENGINEERING Obrero, Davao City

INDUSTRIAL PROCESSES AND PLANT INSPECTION FIELD TRIP WAIVER OF CLAIM

I, ___________________________________________, of legal age and residing at __________________________________________________ will be undergoing an Industrial Processes and Plant Inspection Field Trip with CITOM Traffic Control (ECE), SALCON Power Corporation (ME, EE), URATEX Foam Philippines (ME, EE), Coca-Cola Bottlers Philippines (ME, EE), KYOCERA Crystal Device (ECE), Ayala Center Electrical Wirings Department (EE), Wellmade Motors Corporation / METAPHIL (ME), National Telecommunications Commission (ECE), Visayan Electric Company (EE), FAIRCHILD / SMART Communications (ECE), Tsuneishi Heavy Industries (ME), ABS-CBN Broadcasting Corporation (ECE), Cebu Mitsumi (ECE), Treasure Island Paints (ME), International Pharmaceuticals, Inc.(ME, EE), Mactan-Cebu International Airport Authority (ECE), Gardenia Philippines (ME, EE), Monolithic On-Going Construction Electrical Wiring (EE), PAGASA Weather Forecast MIS Department (ECE), TERADYNE Philippines Limited (ECE), SKYCABLE TV Channel (ECE), East Asia Utilities, Inc. (EE), APO Cement Corp. (ME, GEO, Mining), USC-TC Concrete Soil Test & Hydraulic Simulation Lab (GEO & Mining), USC-TC Water Resources with brief Lecture (GEO & Mining), BETONVAL Ready Concrete, Inc. (GEO & Mining), Mines and Geo-Science Bureau VII (GEO & Mining), Philippine Mining Service Corporation Dolomite Mining Corporation (GEO, Mining), Solid Earth Development Corporation (GEO, Mining), SRP Desalination Plant (DP) Sewage Treatment Plant (STP), PAGASA Weather Forecast with Lecture (GEO, Mining), Carmen Copper Corporation (GEO, Mining) and other identified cooperating agency/company on November 18-24, 2013 through the request of the College of Engineering, University of Southeastern Philippines and in consideration therefore, I hereby freely and voluntarily assume and impose upon myself the following duties: 1. That I recognize the authority of my cooperating agency/company in which I may be undergoing the field trip and submit myself to all the rules and regulations that may be imposed by them related with the field trip, and 2. That I renounce and waive my claim against the cooperating agency/company and the USEP - College of Engineering, for any injury that I may sustain least that I suffer personal/pecuniary, in the performance of my duties and functions during the field trip. Signed in Davao City, this _________ day of ____________________ 2013.

____________________________________ Signature of Student-Trainee WITH THE CONSENT AND APPROVAL OF PARENT OR GUARDIAN:

Parent/Guardian: __________________________________________ Address: ________________________________________________ Community Tax Number: __________________________________ Issued at: ______________________________ Issued on: ________________________

____________________________________ Signature of Parent/Guardian Witnesses:

____________________________________ Department Head

DR. ROSELLO LYNDON H. ROBLE Dean