INTERNSHIP AGREEMENT

This internship agreement is entered upon between San Pedro College-

________________ Department and the parents or legal guardians of ________________.

It is hereby acknowledge by the undersigned parents or legal guardian that they have
read, understand and voluntarily agreed to comply with the provisions of the internship
program of San Pedro College- ________________ Department as provided by the Clinical
Internship Manual and the stipulations enumerated herein.

1. PRE-INTERNSHIP CONDITIONS/REQUIREMENTS

No students will be admitted to the internship program unless he/she have

completed on all the conditions/requirements provided in the MLS Internship Handbook. (See
MLS-IP handbook page 14)

2. INTERNSHIP RULES AND REGULATIONS

Students shall strictly comply with the conditions and guidelines set by the San
Pedro College Student Handbook and MLS Internship Handbook. The same reference will used
for the students’ decorum and misconducts (See MLS-IP handbook page 14-19)

3. PROCEDURE FOR DISCIPLINARY ACTION

The sanctions and mechanism and procedures as provided by MLS Internship

Handbook shall used to address disciplinary infractions by students. (See MLS-IP handbook
page 19-23)

4. ADDITIONAL INTERSHIP CONDITIONS/REQUIREMENTS

Students shall comply the additional conditions/requirements for those who will have
their internship outside Davao City. The following are the conditions & requirements:

1. The clinical instructor/clinical internship coordinator facilitates for the

accommodation of students in their assigned area, the group of interns assigned to
a specific laboratory must live together to promote group accountability and safety.
Should there be a case that intern(s) wish to transfer to another accommodation of
their own preference, then this should be upon the approval of the clinical internship
coordinator and a corresponding waiver must be submitted to the Dean of MLS
Department.
2. During the entire rotational assignment in Tagum & Panabo area, the intern is
strictly prohibited from going to mountain resorts, beach resorts, amusement parks,
bars and the like. This is to ensure the safety and security of the interns.
Corresponding sanctions will be imposed if an intern will not comply with this
mandate.
3. During their free days, family, relatives and friends of the interns may visit them in
their respective transient homes. The intern however is not allowed to go and stay
on their nearby relatives for over-nights and the like without prior approval from the
Clinical Internship Coordinator.
 5. WAIVERS AND QUITCLAIMS

In compliance with the requirements of the different institutions to where the

internship program will be implemented, the parents or legal guardians of the students must
execute valid waivers and quitclaims.

6. DURATION AND LOCATION OF INTERNSHIP

The internship program will cover the period of November 19, 2018 to May 2019
or six (6) months and will be distributed randomly and accordingly to the different accredited
training institution.

Done this ________day of ___________________ 20___ at Davao City, Philippines.

_________________________ ________________________________
Name and Signature of Student Name and Signature of Parents/Legal Guardians

________________________________ _______________________________________
Aileen Grace L. Ang, RMT, MSBio, MSMT Juliie J. Tiu, RMT, MPH, MSMT
Clinical Internship Coordinator Department Dean

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

CITY OF D A V A O …. ) SS
x_____________________________x

BEFORE ME, a Notary Public for and in the City of Davao, Philippines, personally
appeared the above named parties with their individual competent evidence of identity
written below their names known to me to be same persons who executed the foregoing
instrument and they acknowledge that the same is their free and voluntary act.

That this Agreement, consisting of TWO (2) pages including this page whereon the
acknowledgement is written has been signed by the parties and their instrumental witnesses
on each and every page thereof.

WITNESS MY HAND AND SEAL this ___ day of _____________20__, at Davao City
Philippines.

Doc.No ____
Page No. ____
Book No. ____
Series of 20__


REPUBLIC OF THE PILIPPINES)
CITY OF DAVAO ) S.S.
x----------------------------------------x

AFFIDAVIT OF UNDERTAKING AND WAIVER

I, _____________________________________________ of legal age, Filipino, is, and a resident of
______________________________________________________________ Philippines, after having been duly
sworn to in accordance with law, do hereby depose and say:

1. THAT, I am the same person as above described;

2. THAT, I am an applicant for the Internship Program of San Pedro College

_______________________________________Department;

3. THAT, in relation thereto I will be undergoing internship trainings to the following institutions for the
durations as listed;

NAME OF INSTITUTIONS PERIOD HOURS

a.
b.
c.
d.
e.
f.

4. THAT, I undertake to strictly and religiously follow the rules and regulations of the above listed
institutions during the duration of my internship program;

5. THAT, I voluntarily relieved the above listed institutions of any liabilities arising from any injury or
accidents that may arise during my internship at their institutions due to my fault or negligence;

6. THAT, the internship program is solely for compliance of my course curriculum and does not
establish any employer-employee relationship with them, nor I am entitled to any allowance or wages
nor they are not obligated to hire me afterwards;

7. THAT, this affidavit is executed in good faith without any purpose of defrauding anyone;

8. THAT, I am executing this affidavit to attest to the truth of the foregoing facts, and for whatever legal
purpose it may serve.

IT WITNESS WHEREOF, I have hereunto set my hand this _____________ day of

_____________________, 20__ at Davao City, Philippines.

__________________________ with parental consent of: ___________________________

Student Parent/Guardian
SPC School ID no. _______________ Government ID No. ___________

SUBSCRIBED AND SWORN to before me this _____________ day of _____________________,

20__at Davao City, Philippines the affiant exhibited to me their Competent Evidence of Identity written below
their names.

DOC NO. _______;

PAGE NO. ______;
BOOK NO. ______ ;
SERIES OF 20__