“KAGANDAHANG-LOOB” WRITER’S CONSENT FORM

WRITER’S NAME: _________________________________________

DATE OF
BIRTH PLACE OF BIRTH AGE GENDER PARISH
(DD/MM/Year)
M ___ F
___

CONTACT INFORMATION

ADDRESS: ___________________________________________________________________
LANDLINE: ____________ MOBILE NO.: _______________ FAX NO.: ____________
EMAIL: ______________________________________________________________________

I am aware that the Vicariate of San Antonio de Padua, Diocese of Parañaque, will publish an
eBook of narratives and reflections, and that I have read and fully understood the guidelines and
hereby accept the same. I hereby grant my unequivocal consent for the Vicariate to use, publish,
and re-publish my narratives, reflections, essays, and any forms of composition to be part of its
eBook in celebration for the 500 years of Christianity in the Philippines.

In addition, I likewise provide my unequivocal consent for the Vicariate to use and process my
above personal data for purposes of the said publication or re-publication, as may be necessary.
Consequently, the Vicariate (the Sponsor) shall have the concurrent and non-exclusive right
to exercise the copyright and other intellectual property rights granted to the author. This right
also extends to all forms of storage, transmission, dissemination, and communication presently
existing or subsequently created.

________________________________________ ______________________________
Author’s Printed Name Author’s
Signature

(NOTE: If the writer is a minor, the following should be accomplished by the parent or legal
guardian.)

PARENTAL CONSENT
(For writers who are minors.)

I, the undersigned parent and/or legal guardian of ___________________________________,

hereby execute this document on his/her behalf

______________________________
Printed Name and Signature
(Parent/Legal Guardian)

Vicariate of San Antonio de Padua, Diocese of Parañaque