Basic Education Department-Manila Parent Consent Form, series of 2021

UNIVERSITY OF THE EAST

Philippines

DATA PRIVACY CONSENT FORM FOR PARENT/GUARDIAN OF

STUDENTS BELOW 18 YEARS OLD
As a parent/guardian, I am fully aware that the Basic Education Department-Manila (BED-Mla) of the
University of the East (UE) is duty bound and obligated under the Data Privacy Act of 2012 to protect all
personal and sensitive information of its students.
Students’ personal data includes any information about their identity, academics, or medical
conditions. This includes but is not limited to the name, address, names of parents or guardians, date of birth,
grades, attendance, disciplinary and health records, school fees and other information necessary for basic
administration and instruction.
I understand that the personal data about my child/ward cannot be disclosed without my consent. I
understand that the information that was collected and processed relates to his/her enrollment and to be used
by the BED-Mla to pursue its legitimate interests as an educational institution. Likewise, I am fully aware that
BED-Mla may share such information to affiliated or partner organizations as part of its contractual obligations,
or with government agencies pursuant to law or legal processes.

In the facilitation of Online and Distance Education (ODL) under Flexible UE Learning (FUEL), I give
my consent to the following:
● BED-Mla’s teachers, counsellors, or designated personnel to record their synchronous/consultation
sessions and/or class pictures which include my child (ward)
● BED-Mla or its designated personnel may use parts of the recorded synchronous sessions and class
pictures for documentation purposes and for activities/materials related to promoting BED-Mla and UE
such as, but not limited to, announcements, advertisements, recognitions, acknowledgments,
promotions, and campaigns in any and all media, as well as publication on the Internet.
● The recorded synchronous sessions/consultations and class pictures will be stored in a secure location
and will be disposed of the end of the school year.
● BED-Mla’s designated personnel other than my child’s (ward’s) adviser may enter the synchronous
sessions for observation purposes and to ensure quality of instruction.
● Teachers, counsellors, or designated personnel may contact me for matters related to my child’s
(ward’s) enrollment, activities that I might be involved with or interested in, and for emergency
purposes. Thus, I give the following personal information:

STUDENT NAME
GIVEN NAME MIDDLE SURNAME
INITIAL

SECTION/
GRADE LEVEL
STRAND

MOTHER’S NAME
GIVEN NAME MIDDLE SURNAME
INITIAL

MOBILE LANDLINE
NO. NO.
CONTACT
INFORMATION
OFFICE EMAIL
NO. ADDRESS

FATHER’S NAME
GIVEN NAME MIDDLE SURNAME
INITIAL

MOBILE LANDLINE
NO. NO.
CONTACT
INFORMATION
OFFICE EMAIL
NO. ADDRESS

These information will be stored in a secure location and will be disposed of after the current school year.

Signed:

Signature

Name of the Parent / Guardian

2219 C. M. Recto Avenue, Brgy. 404, Zone 41, Sampaloc, Manila ● Telephone no. +632 8735 54 71
105 Samson Road, Brgy. 80, Caloocan City ● Telephone no. +632 8367 45 72
 Basic Education Department-Manila Parent Consent Form, series of 2021

date

2219 C. M. Recto Avenue, Brgy. 404, Zone 41, Sampaloc, Manila ● Telephone no. +632 8735 54 71
105 Samson Road, Brgy. 80, Caloocan City ● Telephone no. +632 8367 45 72