Internship Agreement

AGREEMENT CONTRACT
Entered into and by and between these parties:

Kidapawan Doctors College, Inc. represented by the VP for Academic Affairs, Ms.
CRISTINA D. COLLENA herein referred to as the “First Party”.
And
PARENTS NAME the parent or legal guardian of STUDENTS NAME herein referred to
as “Second Party”.
ALL PARTIES AGREE TO THE TERMS OF THIS AGREEMENTS AS FOLLOWS:

Article 1: Internship Program
This internship is an integral part of the student’s academic program of study
Institution and is designed to offer students the opportunity to gain valuable work
experiences as integral part of the Internship Program.
Article 2: Pre – Internship Conditions and Requirements
No students will be admitted to the internship program unless he/she have
completed on all the conditions/requirements provided in the Department’s Internship
Handbook
Article 3: Internship Rules and Regulations
The Student shall strictly comply with the conditions and guidelines set by the
Kidapawan Doctors College, Inc. Student Handbook and the Department’s Internship
Handbook. The same reference will be used for the student’s decorum and misconducts.
Article 4: Procedure for Disciplinary Action
The sanctions and mechanism and procedures as provided by Department’s
Internship Handbook shall be used to address disciplinary violations by students.
Article 5: Additional Internship Conditions & Requirements
Students shall comply the additional conditions/requirements for those who will
have their internship in any Affiliated Institution. The following are the conditions &
requirements:
1. The Internship Coordinator with the approval of the Program Head facilitates for
the accommodation of students in their assigned area. The group of interns
assigned to a specific affiliated institution must live together to promote group
accountability and safety. In case that intern(s) wish to transfer to another
accommodation of their own preference or live with relatives, upon the
recommending approval of the internship coordinator, clinical instructor or
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internship preceptor, a corresponding signed and approved waiver must be
submitted to the Department’s Program Head/Coordinator.
2. During the entire rotational assignment in the Affiliated Institutions, the intern
must follow the following:
2.1 Interns are 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.
2.2 Curfew hour shall be set at 9:00 P.M. except for Interns scheduled to Night
Shift Duty.
2.3 In case interns wish to go out for valid reason upon the approval of the C.I.
(i.e. go to market to buy food or personal things), a log book shall be
provided to monitor the in and out of Interns from the transient home where
they live together.
2.4 Assume all of the foregoing risks and accept sole responsibility for any injury
of the intern (including, but not limited to, personal injury, disability, and
death), illness, damage, loss, claim, liability, or expense, of any kind, that the
intern may experience or incur.
2.5 Acknowledge the contagious nature of certain diseases and voluntarily
assume the risk that intern may be exposed to or infected by attending the
Affiliation Program and that such exposure or infection may result in personal
injury, illness, permanent disability, and death.
2.6 The intern will fully and personally responsible for his/her own safety and
actions while and during his/her participation to the Affiliation Program.
3. During their free days, family, relatives and friends of the interns may visit them
in the transient homes. The intern however is not allowed to go and stay on their
nearby relatives for over-nights and the like unless otherwise is an urgency and
with the approval of the C.I. and the Program Head or Coordinator. Clinical
Instructor and Preceptor will not be held accountable of the interns after duty
hours or day off.
4. Interns must complete a total of 1,056 duty hours per semester. Interns which
exceed to 240 hours or 30 days of duty absences will be suspended from
enrolling to second semester or will not be able to graduate.
Article 6: Requirements for Graduation
Interns will be included to the list of graduates once the following requirements are
met:
a. Satisfactorily completed all academic requirements;
b. Passed the Comprehensive examination;
c. Signed and approved hard bound of thesis manuscript;
d. Completed the required number of duty hours; and
e. Accomplished Internship Case Logbook.
Failure to comply with the abovementioned requirement will not be able to graduate
as per requirement under CHED Memorandum Order No. 07, Series of 2018.
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Article 7: 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.
Article 8: Duration and Location of Internship

The internship program will cover the period of July 10, 2022- June 30, 2023 and will
be distributed randomly and accordingly to the different accredited training institutions.
Article 9: Acknowledgement of Understanding

It is hereby acknowledged 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 Kidapawan Doctors College, Inc. Radiologic Technology Department
as provided by the Internship Manual and the stipulations enumerated herein.
IN WITNESS WHEREOF, both parties affix their signature in this ___________ day of
_______, 2021 at ______________________________.
FIRST PARTY: SECOND PARTY:
CRISTINA D. COLLENA, MAE _____________________________

VP for Academic Affairs Parents/Guardian of Intern
Witnesseth:
CEDRICK B. MELANO, RRT, MPA ____________________________

Program Head Student Intern
Page 3 of 4
ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES

CITY OF KIDAPAWAN) S.S.
x-----------------------------------------------x
BEFORE ME, this day of ________________, 20___, Notary Public in and for the
__________________________, Philippines, personally appeared:
Name CTC No. Place & Date Issued

___________________________ _________________ ___________________________
___________________________ _________________ ___________________________
Known to be the same persons who executed the foregoing instrument and they
acknowledged to me that the same is their free and voluntary act and deed.
This instrument consisting of four (4) pages including this page o which this
acknowledgement is written has been signed on each and every page thereof by the parties
hereof and their witnesses and sealed with my notarial seal.
IN WITNESS WHEREOF, I have hereunto set my hand the day, year and place above
written.
Doc.No ________
Page No. _______
Book No. _______
Series of 20____
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AGREEMENT CONTRACT

Entered into and by and between these parties:

ALL PARTIES AGREE TO THE TERMS OF THIS AGREEMENTS AS FOLLOWS:

Article 8: Duration and Location of Internship

Article 9: Acknowledgement of Understanding

FIRST PARTY: SECOND PARTY:

CRISTINA D. COLLENA, MAE _____________________________

CEDRICK B. MELANO, RRT, MPA ____________________________

REPUBLIC OF THE PHILIPPINES

Name CTC No. Place & Date Issued

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