PARENTAL CONSENT FORM

I, _________________________, hereby permit, without any reservations, my

minor child/ward, _________________________, to fully participate in the Department
of Science and Technology - Technology Application and Promotion Institute’s (DOST-
TAPI) Gawad Alunig x Dalumat: Empowering Science Stories through Citizen
Journalism Contest. For this purpose, I further affirm and confirm the following:

1. Video, Photo and Film Consent. I consent to the capturing of my

child/ward in a video/photo/film format for or as an entry/material to be
submitted to the Department of Science and Technology - Technology
Application and Promotion Institute’s (DOST-TAPI) Gawad Alunig x
Dalumat: Empowering Science Stories through Citizen Journalism
Contest, including in any derivative promotional, marketing or publication
materials made as an offshoot, consequence, or furtherance of said
submission/entry.

2. Assumption of Risks. I understand and consent to the content, nature,

and purpose of the event and my child’s participation therein. I understand
that there are certain risks inherent during contest participation, video
production/filming as well as during interviews, film/video screening or
release, and other related activities incidental to my child’s participation in
an entry/material and contest and I am willing to assume all these risks on
behalf of my child.

3. Child/Ward Awareness. I have exhaustively explained to my child/ward

the contents of this form to which he/she confirmed understanding and
consent.

4. Release and Waiver. I hereby 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.
 5. Warranty. I warrant that I possess all the rights, powers, and privileges
of a parent or legal guardian necessary to execute this document with
binding legal effect.

6. Separability Clause. Should any provision of this Document or any part

thereof be declared invalid, the other provisions, insofar as they are
separable from the invalid ones, shall remain in full force and effect.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

______________, in ______________, Philippines.

__________________________
Signature over printed name
(Parent/Legal Guardian)