LYKEIOS PRIMER

COLLEGE/DEPT: ___________________________ PROGRAM/STRAND: __________________________ MAJOR/SPECIALIZATION: ______________________

NICKNAME

NAME

Given Name

Middle Initial

Last Name, Suffix (if you have Jr./Sr/ II/III)

BIRTHDAY _________________________________________________ (MONTH/DAY/YEAR)

HOME ADDRESS ______________________________________________________________________________________________________________________________

EMAIL ADDRESS: _____________________________________________________________________(PREFERABLY YOUR LPU EMAIL ADD. THIS WILL NOT
APPEAR ON THE YEARBOOK)

FACEBOOK: ______________________________________________________________________________(THIS WILL NOT APPEAR ON THE YEARBOOK)

Data Privacy Consent and Agreement with LPU Batangas

I hereby declare that by signing this primer and creating my profile:

1. I attest that the information I have written is true and correct to the best of my personal knowledge;

2. I signify my consent to the collection, use, recording, storing, organizing, consolidation, updating, processing, access to transfer, disclosure or data
sharing of my personal and sensitive personal information that I provided to LPU-B including its sister schools/ universities, industry partners, affiliates,
external providers, local and foreign authorities regardless of their location and/or registration for the purposes for which it was collected and such other
lawful purposes I consent to or as required or permitted by law;

3. I understand that upon my written request and subject to designated office hours of the LPU-B, I will be provided with reasonable access to my personal
information provided to LPU-B to verify the accuracy and completeness of my information and request for its amendment if deemed appropriate, and;

4. I am fully aware that the consent or permission I am giving in favor of LPU-B shall be effective immediately upon signing of this form and shall continue
unless I revoke the same in writing. Sixty (60) days upon receipt of the written revocation, LPU-B shall cease from performing the acts mentioned under
paragraph 2 herein concerning my personal and sensitive personal information.

5. I shall comply with and complete all the requirements required and set by the Yearbook Committee for Lykeios. In the event that I shall fail, I shall be
excluded from the final list of students who will appear in the printed yearbook and I shall waive my right to demand a refund of the amount paid for the
picture and yearbook packages. I hereby give my full trust and support in order that we attain our common goal of coming out with the best Lykeios
Yearbook.

6. That the information I have provided is subject to verification and proofreading by the Yearbook Committee. I also understand and agree that if I do not
claim my Yearbook and Photo Package within two (2) years after the release of the yearbook, both my yearbook and photo package will be disposed of,
thus I can no longer claim nor refund anything from LPU Batangas.

DATE of RELEASING OF THE YEARBOOK SHALL BE POSTED ON OUR WEBSITE and our Official Social Media Pages (please follow @lpubofficial)

LYKEIOS: (please tick appropriate box)

2022 2021 2020

_________________________________________
Signature of Student/Date

--------------------------------------------------To be filled out by Yearbook Staff------------------------------------------------------------------

No. Date of Pictorial: _________________________ Remarks:

Name/Signature of Yearbook Staff: _________________________