ATHLETE DATA PRIVACY NOTICE AND CONSENT FORM

The Department of Education engages in the collection of

personal information such as the full name, address, age, medical and
dental records, photographs, Learner Reference Number, school
records, parental information, and contact information of its student
athletes.

All personal information collected by the Department shall be

utilized for accounting, auditing, screening, qualifying, performance
monitoring, and other legitimate purposes for the conduct of athletic
meets, sports competitions, practices, and the publication of results of
sports activities and competitions.

All information collected shall be processed, utilized, retained,

and disposed by authorized personnel in accordance with the relevant
policies of the Department on usage, retention, and disposal of its
records.

For concerns regarding data collection, access, disclosure,

correction, and other issues, inquiries may be made to the compliance
officer for privacy, ____________________________, ROSEMARIE D.
TORRES, CESO VI,
School Head Schools Division Superintendent
DR. DIOSDADO M. SAN ANTONIO at calamba.city@deped.gov.ph and (049)-
5455797.
Regional Director school email address Contact
Number

In consideration of the foregoing, I hereby auhorize the

Department of Education to collect, use, and process the above-
specified personal information for screening, qualification, participation
in athletic activities, athletic practices and training, and publication of
results in athletic activities and competitions. In the course of my
application to participate in school, division, regional, national, and
international activities and competitions, I hereby authorize the
Department of Education to transmit relevant personal information to
authorized Department personnel to process such application.

I am hereby authorizing the Department of Education to collect,

process, retain, and dispose of my personal information in accordance
with Department policies.

Date: ________________________

_____________________________________
Signature above printed name
Student-athlete

__________________________ ________________________
Signature above printed name Signature above printed
name
 Parent/Guardian Parent/Guardian

Witnessed by:

________________________________
Signature above printed name
Teacher/Coach

COACH DATA PRIVACY NOTICE AND CONSENT FORM

The Department of Education engages in the collection of

personal information such as the full name, address, age, medical
records, photographs, educational and training qualification, and
contact information of its coaches.

All personal information collected by the Department shall be

utilized for accounting, auditing, screening, qualifying, performance
monitoring, and other legitimate purposes for the conduct of athletic
meets, sports competitions, practices, and the publication of results of
sports activities and competitions.

All information collected shall be processed, utilized, retained,

and disposed by authorized personnel in accordance with the relevant
policies of the Department on usage, retention, and disposal of its
records.

For concerns regarding data collection, access, disclosure,

correction, and other issues, inquiries may be made to the compliance
officer for privacy, ____________________________, ROSEMARIE D.
TORRES, CESO VI,
School Head Schools Division Superintendent
DR. DIOSDADO M. SAN ANTONIO at calamba.city@deped.gov.ph and (049)-
5455797.
Regional Director school email address Contact
Number

In consideration of the foregoing, I hereby auhorize the

Department of Education to collect, use, and process the above-
specified personal information for screening, qualification, participation
in athletic activities, athletic practices and training, and publication of
results in athletic activities and competitions. In the course of my
application to participate in school, division, regional, national, and
international activities and competitions, I hereby authorize the
Department of Education to transmit relevant personal information to
authorized Department personnel to process such application.

I am hereby authorizing the Department of Education to collect,

process, retain, and dispose of my personal information in accordance
with Department policies.
Date: ________________________

_____________________________________
Signature above printed name
Coach
 CONFIDENTIALITY UNDERTAKING

I, , of

Name of Coach Designation Office – Name of School

hereby understand that highly confidential
Agency
is being collected and processed from the conduct of the athletic
activities and competitions within the Department of Education. I
hereby affirm that I am authorized and designated to handle and control
the said information in confidence.

In this regard, any information gathered and processed will be

kept confidential and will not be disclosed, divulged nor used beyond
its intended purpose. It may not be reproduced in whole, or in part, nor
may any of the information contained therein be disclosed without the
prior notification or consent of the data subject concerned nor of the
Department of Education.

Furthermore, I acknowledge that the illegal and or unauthorized

disclosure or use of information collected and processed shall be
subject to administrative and criminal liability under the law.

____________________________________________________
SIGNATURE OVER PRINTED NAME OF COACH
 SECURITY CLEARANCE

I hereby certify that the following personnel indicated below are

authorized to collect, process, retain, and dispose of personal
information of learners in accordance with the Data Privacy processes
and policies of the Department of Education:

NAME DESIGNAT TYPES OF PERIOD OF SIGNATUR

ION DOCUMENTS OR VALIDITY OF E
PERSONAL SECURITY
INFORMATION CLEARANCE
Coach AR-1, PSA, Form 137, For Palarong
Certificate of Enrolment, Pambansa Only
Certificate of
Completion, Parental
Consent, Medical
Certificate, Dental
Certificate, other related
documents.

All learner records are highly confidential pursuant to the

provisions of BP 232 and other relevant laws, rules, and regulations.
Only the designated personnel may handle these personal information
within the period of validity of their security clearance.

______________________________________________
(Head of School/Division/Regional Office)
Signature Above Printed Name

Name of School:________________________
Division: SDO Calamba City
Region: IV – A CALABARZON