CONSENT AND RELEASE FORM

I, ______________________, Filipino, of legal age, (single/married/widow), and

resident of _________________________________, understand that this document is
an important legal document relating to my submission entry in the Gawad Alunig x
Dalumat: Empowering Science Stories through Citizen Journalism Contest by the
Department of Science and Technology - Technology Application and Promotion
Institute (DOST-TAPI). For this purpose, I further affirm and confirm the following:

1. By signing this document, I am waiving all legal rights that I may have against the
organizers, partners and sponsors of the aforementioned contest.

2. I remain the ownership of the intellectual property of the entry saved for the
following exceptions:
a. I voluntarily grant DOST-TAPI the right to use my name, photographs,
statements, quotes, testimonials, and video material or entry or any part of
it, for non-commercial purposes, without notification or further
compensation;
b. I acknowledge that DOST-TAPI has the right to use, edit, reproduce,
distribute, perform, and/or display my material or entry, or any part of it,
without further compensation or notification from me; and
c. I agree that DOST-TAPI maintains its right to use, reproduce, distribute,
perform, display, or exhibit my material or entry on their social media,
website, and other media platforms or venues.

3. I shall be solely liable for any claim/s of privacy violations, plagiarism or breach of
any Intellectual Property Rights that third party or parties have or may have
against my Entry or Material and hereby free or absolves DOST-TAPI, its
management and officials, partners and sponsors, completely and absolutely
from any liability or accountability arising therein.

4. Further, I release, waive, forever discharge, hold harmless and covenant not to
sue DOST, DOST-TAPI, it’s secretary, undersecretary, directors, program
managers, employees, contractors, partners, endorsers, representatives, or
affiliates related in any way to the above-mentioned campaign from any and all
actions, liabilities, costs, expenses, claims or demands, whatsoever relating to
the making, performing, submission, exhibiting, and distribution of my submission
entry in the contest stated above.
 IN WITNESS WHEREOF, I have hereunto affixed my signature this
______________, in ______________, Philippines.

__________________________
Signature over printed name
(Participant)