CONSENT FORM

We, Celina Jane Magpantay andConcepcion M. Talastas, hereby execute this Consent
Form allowing my son/daughter to undergo practice teaching internship for a minimum of 360
hours beginning until at Bernardo Lirio Memorial
National High School with school address at Darasa, Tanauan City, Batangas in partial
fulfillment of the requirement for the EDUC 30236 Practice Teaching.
We are aware that the immediate superior within the school will take all the necessary
precautions to keep the students safe. The OJT and Quality Assurance Coordinators will also be
there to periodically monitor the performance and safety of the students.
We execute this Consent Form inaccordance with our free will, realizing the benefits that
the student intern shall obtain from the said on-the-job training/internship program.

CEUNA JANE MAGFANTAY

2. felaelana
CONCEPCION M- TALsSTAS
(Name and Signature of (Name and Signature of
Student Intern) Parent/ Guardian)

REPUBLIC.OF THE PHILIPPINES

CITY OF )S.s.
Province of Batangas FEB AEB .97 2025,
Subscribed and sworn to before me, this at
Province of Batangas , Philippines, affiants exhibiting valid proofs
of their identity as follows:
Name ID No. lssued at/on

Celina Jant Maggantay 04 -473I5%-3 Leimt yoidiky

Coctpcion M. Talactas 2022- I o l Lfene Votidiy

They acknowledged to me that the foregoing Consent Form was executed in accordance
with their own free will.

NOTARY PUBLIC
6. IRINIDA
Face No.4PUBLIS INES
Book-NO.
`eriesof ATTYENIGDG TRINDAD, JR.
For andintne
Malvar. a l oflena
t , i l l , TD tho Municipslties of
PHI r eof Caloncas
TANU OLLIBATANGAS t n shd unhl I December 2025
 INTERNSHIP AGREEMENT

I, Celina Jane Magpantay, with the consent of my parent/guardian, Concepcion M.

Talastas, aBachelor of Technology and Livelihood Education Major in Home Economics
student of POLYTECHNIC UNIVERSITY OF THE PHILIPPINES STO. TOMAS CAMPUS, with
principal address at A. Bonifacio St. Poblacion I, Sto. Tomas Batangas, hereinafter referred to
as "UNIVERSITY", as part of the school curriculum or academic requirement voluntarily agrees
to undergo Practice Teaching at the Bernardo Lirio Memorial National High School with school
address at Darasa, Tanauan City, Batangas, hereinafter referred to as "SCHOOL". The
Practice Teaching shall start on and ends on is
covered by the following terms and conditions:
1. The duration of the program shall be equivalent to at least 360 hours unless otherwise
agreed upon by the parties.
2. The OJT shall be held for a maximum of 8 hours a day only.

3. Ishall be fully accountable to the School Representative or his/her designated

representative under whom I will be trained.

4. Ishall abide by all the policies and procedures of the SCHOOL in the duration of my
internship.

5. Ishallsubmit a Medical Certificate indicating that Iam in good health and emotionally
fit. The Medical Certificate shall be based on a physical and psychological examination
conducted or certified by the Department of Health (DOH) accredited clinics and
hospitals. Ishall also submit other related medical examination requirements by the
SCHOOL, if any. (See Annex A")
6. | am fully aware of the internship plan developed by the SCHOOL and the
UNIVERSITY specifying the goals and objectives of the On-the-Job Training
(0JT)/Internship Program. (See Annex B)
7. Ishallexercise extreme care and diligence in any work or task assigned to me.
8. I willsubmit a journal of internship, as may be required by the SCHOOL, reflecting
on the approved internship plan, my experiences describing the internship activities,
any problem/s encountered, and my reflections on the internship experience to the
OJT and Quality Assurance Coordinator.

9. Ifully acknowledge that the SCHOOL shall not be duty-bound to pay costs nor any
form of remuneration or compensation for such.

10. I am fully aware that my training is not a guarantee of my immediate or eventual

employmernt at the SCHOOL as the latter reserves the right to select its employees in
accordance with its established hiring and recruitment policies and procedures.

11.1,together with my parents/guardian shall be responsible for any and all loss, damage,
injury, expense, proceeding, demand, cost, claim,suit or liability incurred by me arising
from my own omission or gross negligence in the performance of my duties and
functions while under internship except such loss, damage, injury, expense,
proceeding. demand, cost, claim, suit or liability which may arise by reason of the
nealigent act or omission of the SCHOOL, its officers, employees, representatives or
agents.

12.Iam fully aware that, should I, in the course of my internship, accidentaly or

deliberately cause damage to any property or resources owned and operated by or for
the SCHOOL, i.e. equipment, machine, apparatus, paraphernalia, device and other
similar nrnredure therenf I shallhe helrt resnonsihle for the same and shall therefore
 pay for the cost of its repairs or replacement, whichever is necessary to restore the
property into full operations.
13.I shal treat in strictest confidence and shall not disclose any confidential information
and related documentation concerning the SCHOOL, in whatever form provided, and
cannot use any confidential information or data from the SCHOOL to create intellectual
property without the express written approval of the latter. Ishall take all necessary
precautions to prevent any unauthorized disclosure or use of such confidential
informationby third parties. Confidential information refers to all information including,
without limitation, a compilation, program, device, method, system, technique or
process possessed by, or developed for the SCHOOL that is not publicly known, and
which information the latter seeks to protect from isclosure to its existing or potential
competitors and other third parties. This also includes information received by the
SCHOOL from other sources that latter has an obligation, express or implied, to treat
as confidential.

14. Iam aware that the SCHOOL reserves the right to revoke, to terminate or to defer this
training experience for purposes of preserving and maintaining the good image of the
SCHOOL.

IN WITNESS WHEREOF, the parties hereby affix their signatures this day of
20 at , Philippines.

CELINA JANE MAGPANTAY

(Name and Signature of
Student Intern)

GLADYsR. BISCOCHO, PhD

CONCEPCON M- TALATAS Principal II
(Name and Signature of (Name and Signature of
Parent/ Guardian) Authorized Representative of School)
(Position)
(Name of School)
 ACKNOWLEDGMENT

Republiçof the Phlippines)

Cityoflty of Täalan )S.S.
Province of Batangas
BEFORE ME, a Notary Public, for and in the City ofty UT lanauai), thísB 9 laA25f
20 personally appeared:

Name ID No. Issued at/on

Celing ait Magpatay 04- 4735

SENIO (D
lanctpcim M. Talastes 2022- It-Mo utfime aledta
Ghadys R. Bikocho 20 -4G240
known to me to be the same persons who executed this instrument and acknowledged the same
to me as their free and voluntary act and deed.

Thisdocument consists of three (3) pages including the page where this Acknowledgment
is written, and the parties signed at the left margin of each and every page hereof.

WITNESS MY HAND AND SEAL on the place and date first above written.
Notary Public

DOAOAkT PUEG. TRINI

Raye No
BMok No.
ATTY. HEkMINIGILDb G/TRIEDAD, JR.
otary Pub
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44542
BATANSAS,
PHILIPP
For andin the Ciies F
Tanau Tesand the Muniipalties of
Malyar. Bal-i2. Teisay &Laral. lne
ROLL OF Province of
Eatan,3s
ATTORNE'
NOTARIAL COMNSON N0.
S 445 42!04May i333
7Ni urhl 21
IE NO222.z021ziangns Chapter De:ennber 2025
pTR NO 0)70!N
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