PHYSICAL EDUCATION STUDENT CONSENT FORM

In compliance with Republic Act 10173 or the Data Privacy Act of 2012 and its Implementing Rules and
Regulations (IRR) and other relevant policies, including directives and issuances of the National Privacy
Commission, I hereby give my consent to Trinity University of Asia (TUA) through its employees or
representatives to collect, use, store, process, release, share, and dispose my personal information such as my full
name, age, date of birth, gender, civil status, course, contact information, home and email addresses,
parents’/guardians name, family background, religion, nationality, government issued ID numbers,
face/photos/videos, medical history and condition, other official and legal purposes in the course of my stay with
TUA.

I fully understand the foregoing and I hereby free Trinity University of Asia from any legal suit in connection with
the processing of my personal information for purposes cited above.

Signature over Printed Name Date Signed