Immaculate Conception Academy

City of Dasmariñas, Cavite 4114

DATA PRIVACY CONFORME AND QUITCAIM

I acknowledge that I have read and understood the ICA Data Privacy Notice. I knowingly give my
full consent for ICA to collect, use, store, or process the videos I submitted for the purpose of
marketing and promotion.

I further expressly agree that in giving this video to ICA, I am not entitled to any remuneration
or benefits and thereby release, remise and forever discharge ICA all claims, demands, cause of
action, or case of whatever nature arising from this promotional video.

_________________________________
Signature Over Printed Name

Parent/Guardian of _______________________________________________________
(child’s name)

Grade: _______________ Section: ______________________ Campus: ___________________

Date: _______________________

Visit us at: www.ica-dasmarinas.edu.ph

Contact Numbers: Main Office: (046) 416-3636 / Registrar's Office: (046) 432-0507 / Director’s Office: (046) 416-4067
Plaza Campus: (046) 416-1295 / North Campus: (046) 506-7525 / South Campus: (046) 402-0052 / East Campus: (046) 432-0507 / West Campus: (046) 416-4875