CONSENT FORM

(for students 18 years old and above)

I, ________________________________, a student in the New Era University, after being duly informed
of my rights under Republic Act No. 10173 (Data Privacy Act) do hereby declare that I understand and
accept the following:

1. I consent to the use and disclosure of my personal information for the upcoming
______________________________ and the corresponding broadcast of the event online and
through other forms of media. This includes the following:
1.1. My photograph or other similar illustrative representation;
1.2. My name; and
1.3. My achievements for the Academic Year 2021-2022.

2. I hereby waive my claim to all legal causes of action, liabilities and damages that may arise from the
disclosure of my personal information. I also waive the rights that I may have under the pertinent laws
regarding the personal information that I have provided, including the right to inspect or approve the
materials prior to broadcast or publication.

3. I hereby authorize the University to make the necessary alterations to the photograph that I have
provided in order to conform with the requirements set by the University for the virtual commencement
exercises.

Date: _________________

Signature over printed name of student:_________________________________

…………………………………………………………

CONSENT FORM
(for students under 18 years of age)

I, ___________________________________________, the parent/legal guardian of

___________________________________ a student in the New Era University, after being duly informed
of my rights under Republic Act No. 10173 (Data Privacy Act) do hereby declare that I understand and
accept the following:

1. I consent to the use and disclosure of the personal information of my child/ward for the upcoming
______________________________ and the corresponding broadcast of the event online and
through other forms of media. This includes the following:
1.1.The photograph or other similar illustrative representation of my child/ward;
1.2.The name of my child/ward; and
1.3.The achievements for the Academic Year 2021-2022 of my child/ward;

2. I hereby waive any claim to all legal causes of action, liabilities and damages that may arise from the
disclosure of the personal information of my child/ward. I also waive the rights that I may have under
the pertinent laws regarding the personal information of my child/ward that I have provided, including
the right to inspect or approve the materials prior to broadcast or publication.

3. I hereby authorize the University to make the necessary alterations to the photograph of my child/ward
that I have provided in order to conform with the requirements set by the University for the virtual
commencement exercises.

Date: _______________

Signature over printed name of parent/guardian : _______________________________