Bacolod City National High School

Science Technology and Engineering Program

P. Hernaez St. Extension, Brgy. Taculing
Bacolod City, Negros Occidental, Philippines
S.Y 2020 2021

STE Consent Form for Photograph Use in (STE Video Promotional)

In accordance with Data Privacy Act of 2012 (Republic Act No. 10173), Freedom of
Information Act (Executive Order No. 2, s. 2016) and the Safe Spaces Act of 2019
safeguarding the use of information and photographs for privacy.

The Science Technology and Engineering (STE) Program requests permission to

use documented photographs of student in the STE Video for promotion among public and
private elementary schools of the Division of Bacolod City. Your child being an exceptional
student and achiever of the program, this request also includes your approval for the use of
his/her photographs. Promotion platform of the video may include the programs official
website and Facebook page.

Yes, I Give consent for the use of my child’s photograph for purposes
consistent to the promotion of the STE Program.

No, I do not permit the use of my child’s photograph for purposes consistent
to the promotion of the STE Program.

*Note: Check the box corresponding to your response.

Name of Student: _____________________________ Date: __________________

Name of Parent/Guardian: ______________________ Signature: ______________

SHEILA V. QUIRINO JOEY IAN C. SINGSON

Master Teacher II Master Teacher I/Officer-in-Charge
STE Program Coordinator Science Dept. & STE Program