Republic of the Philippines

Department of Education
REGION VII - CENTRAL VISAYAS
SCHOOLS DIVISION OF MANDAUE CITY
MANDAUE CITY COMPREHENSIVE NATIONAL HIGH SCHOOL

Parent Consent and Waiver Form

Ako si inahan/ amahan/legal guardian ni ______________________________________________

(Ngalan sa Estudyante) usa ka estudyante sa Mandaue City Comprehensive National High School (Ngalan
sa Eskwelahan) mitugot sa pag-apil sa maong estudyante sa ____________________________ (Ngalan
sa Aktibidad/Proyekto) nga ipahigayon sa ________________ (Ngalan sa Nagdumala)
karong ________ (Adlaw sa Pagpahigayon) didto sa (Lugar sa Pagpahigayon ) _____________________.

Sa partisipasyon sa maong estudyante, ako nakasabot ug nagtugot nga:

a. Siya makabaton ug mga benepisyo ug importanteng kaalam nga dapat niyang gamiton sa pang-
adlaw-adlaw ug ipaambit ngadto sa uban;
b. Siya muparticipar sa tanan nga bulohaton nga apil sa maong kalihukan o aktibidad;
c. Siya badlongon sa mga nagdumala sa maong kalihukan o aktibidad kung siya dill musunod sa mga
patakaran niini o kaha siya makakawsa ug risgo sa iyang kaugalingon ug sa ubang tawo;
d. Siya makuhaan ug hulagway ug video isip dokumentasyon sa paghimo sa maong aktibidad ug kini
pwedeng gamiton sa eskwelahan ug sa tagdumala alang sa maong proyekto o mga pagsibyaniini sa mga
opisyal nga pamantalaan sa eskwelahan ug ni DepEd; ug
e. Siya maghatag ug mga personal nga impormasyon mahitungod sa iyang
(isaysay ang mga impormasyon nga koletahon) nga gamiton sa mga nagdumala alang sa katoyoan nga
academiko.

Ako boluntaryo, wala gipugos, wala gihadlok ug wala gilinlang sa paghatag niini nga Parent's
Consent ug Waiver. Akong nakonsiderar ang benepisyo nga makuha sa akong estudyante sa iyang
partisipasyon niining aktibidad. Walay tulubagon sa akong anak, kanako ug sa akong pamilya ang
eskwelahan, DepEd ug mga trabahante ug opiser niini sa mga panghitabo nga gawas sa ilang control
labaw na kung ilang nabuhat ang mga kinahanglan nga pag-amping ug pagbantay ngadto sa akong
estudyante. Kini nagpaila usab sa akong pagbiya sa katungod mahitungod paggamit sa mga nahisgutan
nga personal nga impormasyon sa maong estudyante tungod sa iyang partisipasyon niini nga proyekto.

Busa ako gipakita akong pagtugot pinaagi sa akong pirma niini nga dokumento.
________________________________
Lagda sa Ginikanan/Legal Guardian
_______________________________
Adlaw nga Gipirmahan
 Republic of the Philippines
Department of Education
REGION VII - CENTRAL VISAYAS
SCHOOLS DIVISION OF MANDAUE CITY
MANDAUE CITY COMPREHENSIVE NATIONAL HIGH SCHOOL

Photograph, Video, and Voice Recording Consent, Waiver, Indemnity and Release
Form
I hereby grant permission to the Department of Education, Division of Mandaue City (hereinafter
referred to as "DepEd") and its representatives to (put a cross on appropriate box):
for the:

photograph video record video stream/live stream/web stream

record my voice upload in an online platform my video recordings and photographs
others, specify ___________________ _

for the Name of event: ________________________________________

Location: ___________________________________________________
Date: _______________________________________

For the purpose/s of (put a cross on appropriate box): Uploading the material/s as part of the
program presentations.
Using the material/ s as informational materials
Sharing the materials as informational materials
Keeping the recording for documentation purposes

By permitting DepEd to perform any of the above activities, I understand and agree that the following
pieces of personal and sensitive personal information ("personal information"), as defined in Republic
Act No. 10173 ("DPA"), shall likewise be processed by:
1. Personal Details: Full Name
2. Educational Background: Highest Degree
3. Position and Institutional Affiliation

I allow DepEd and its representatives the rights to (put a cross on appropriate box):

reproduce o keep on record exhibit/ display broadcast/ distribute

create derivative works of these images and recordings in any media now known or later
developed.

I agree and understand that my personal information may be processed both by way of computer
media and on paper, in compliance with the rules on data protection, including those relating to data
security.
 Republic of the Philippines
Department of Education
REGION VII - CENTRAL VISAYAS
SCHOOLS DIVISION OF MANDAUE CITY
MANDAUE CITY COMPREHENSIVE NATIONAL HIGH SCHOOL

I agree that all such portraits, pictures, photographs, video and audio recordings and any
reproductions thereof, and all plates, negatives, recording tape, and digital files shall remain the
property of the DepEd unless otherwise noted. I also agree that all such documents, including the
personal information contained therein, shall be retained or stored for as long as the purposes for which
they are being processed have not been satisfied, and that they shall be retained or stored.

I understand that, as a data subject, I have the right to access personal information, the right to
make corrections to such information, the right to object to the processing of my personal information,
the right to block or erase my personal information, the right to be informed about the processing of my
personal information, the right to damages, and the right to lodge a complaint with the National Privacy
Commission. I also understand that, in the event that I do exercise any of these rights, DepEd may be
unable to fulfill its obligations to me.

Should I have any questions or concerns about my personal information, I may address them to:

Data Protection Officer

Department of Education, Schools Division of Mandaue City
Plaridel St. Mandaue City, Cebu, Philippines
mandaue.city00l@deped.gov.ph
(032)345-0545

I attest that I have read this consent form and fully understand its contents. I warrant that I am
competent insofar as this consent is concerned, as a legal age signee or as minor with the consent of my
parents/guardian.

______________________________________ __________________________
Printed name and Signature of Learner Date of Signing

______________________________________
Grade Level and School

______________________________________
Address of Learner

_______________________________________ __________________________
Printed Name and Signature of Parent/Guardian Date of Signing