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Parental Consent for Student Media

This consent form allows a student's personal information and achievements to be used and disclosed for an upcoming school event broadcast online and through other media. The parent waives any legal claims and rights regarding the disclosure of the student's personal information, photographs, or representations. The parent also authorizes the school to alter any provided photographs as needed for the virtual commencement exercises.

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4K views1 page

Parental Consent for Student Media

This consent form allows a student's personal information and achievements to be used and disclosed for an upcoming school event broadcast online and through other media. The parent waives any legal claims and rights regarding the disclosure of the student's personal information, photographs, or representations. The parent also authorizes the school to alter any provided photographs as needed for the virtual commencement exercises.

Uploaded by

Lea
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CONSENT FORM

(for students under 18 years of age)

I, _______ the parent/legal guardian of __________ (name of student, grade, and section) of this
school, after being duly informed of my rights under Republic Act No. 10173 (Data Privacy Act) do hereby
declare that I understood and accepted the following:

1. I consent of the use and disclosure of the personal information of my child/ward for the upcoming and
the corresponding broadcast of the event online and through other forms of media. This includes the
following:
1.1. The photograph or other similar illustrative representations of my child/ward;
1.2. The name of my child/ward; and
1.3. The achievements for the Academic Year 2020-2021 of my child/ward;

2. I hereby waive any claim to all legal causes of action, liabilities, and damages that may arise from the
disclosure of the personal information of my child/ward. I also waive the rights that I may have under
the pertinent laws regarding the personal information of my child/ward that I have provided, including
the right to inspect or approve the materials prior to broadcast or publication.

3. I hereby authorize the University to make the necessary alterations of the photograph of my child/ward
that I have provided in order to conform with the requirements set by the University for the Virtual
Commencement Exercises 2021.

Date: ________

______________
Signature over printed name of parent/guardian

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