I hereby declare that I am willing to take part in an internship program in Bali facilitated by PT. Griya Lumbung Sari and I understand and agree to the following provisions:

1. Personal Awareness and Responsibility: I realize that while participating in the internship program in Bali, I am fully responsible for my own safety and health. I will always comply with the rules and policies that apply at the internship site and maintain the good name of the hospital/clinic and PT. Griya Lumbung Sari.
2. Risks and Unexpected Events: I am aware that during the internship program, there is a possibility that undesirable events may occur (such as accidents, illness, loss of items, or other incidents) and I declare that I will not sue the hospital/clinic or PT. Griya Lumbung Sari for all forms of losses, both material and immaterial, that may occur during the internship program.
3. Insurance: I realize the importance of having health and accident insurance during my internship program and it is my responsibility to ensure that I have adequate insurance.
4. Compensation: I release the hospital/clinic and PT. Griya Lumbung Sari from all legal claims and obligations for any incidents that I may experience during the internship program. I also promise not to file lawsuits or compensation in any form against hospitals/clinics and PT. Griya Lumbung Sari related to this internship program.
5. Final Statement: Thus, I have made this statement letter truthfully and without any coercion from any party. I fully understand the contents of this statement and am willing to bear all the consequences that may arise.