Calayan Educational Foundation, Inc.
Office of the College of Medical Technology
PACUCOA Level II Accredited
DEED OF UNDERTAKING/INFORMED CONSENT
I, ___________________ a student of Calayan Educational Foundation Inc. Lucena City
referred to as MEDICAL TECHNOLOGY STUDENT and I
______________________,
parent/guardian of the students hereby declare, manifest and undertake the following action to
with:
THAT, the above Medical Technology student shall undergo limited face to face set by
CALAYAN EDUCATIONAL FOUDATION INC. (CEFI), pursuant to Commission on Higher
Education-Department of Health (CHED-DOH) Joint Memorandum Circular No. 001-2021 for
the following subject/s stipulated in Commission on Higher Education (CHED) Memo No. 13,
series of 2017
THAT, I will diligently abide all the schools’ rules and regulations and safety and health
protocols against COVID-19 during my training.
THAT, I will adhere to the minimum school health safeguard like maintaining foot traffic,
wearing of proper personal protective equipment, filling-up a health/declaration form and being
subjected to temperature scan.
THAT, before internship/limited face to face, I will abide with the requirements required
by the school and hospital (like RT-PCR or antigen test if required; PhilHealth Membership with
updated payments etc.)
THAT, during the training, I will comply with the requirements set by the Medical
Technology Department, such as: bringing my own personal hygiene kit containing the following:
ethyl alcohol (70%) or hand sanitizer, cleansing wipes/tissue paper/toilet paper/hand towel, extra
face mask, and hand soap; wearing of white uniform, laboratory gown and gloves during the
execution of procedures, bring own food, observe silence or “No Talking Policy” unless needed,
shall not loiter and observe proper physical distancing.
And THAT I will hold CALAYAN EDUCATIONAL FOUNDATION INC. (CEFI), free from
any liability during the duration of my training.
____________________________
Student’s Name and Signature
__________________________
Parent/Guardian Name and Signature
CALAYAN EDUCATIONAL FOUNDATION, INC.
Maharlika Highway, Lucena City, Philippines • Tel. No. +63 (042) 710-2514 loc 108
www.cefi.edu.ph