COACH DATA PRIVACY NOTICE

AND CONSENT FORM

VERSION NO. REVISION NO. EFFECTIVITY Page 1 of 1 DEPED-6-RSAC02-19

1.0 0.0 DATE:
4 January 2023

The NEGROS OCCIDENTAL AREA V ATHLETIC ASSOCIATIONengages in the

collection of personal information such as the full name, address, age, medical and dental records,
photographs, Learner Reference Number, School ID, school records, parental information and
contact information of the athletes.

These data shall be utilized for accounting, auditing, screening, qualifying, performance
monitoring, and other legitimate purposes for the conduct of NEGROS OCCIDENTAL AREA V
ATHLETIC ASSOCIATION MEET, and the publication of results of games.

All information collected shall be processed, utilized, retained, and disposed by

authorized personnel in accordance with the relevant policies of the Department on usage, retention,
and disposal of its records.

For concerns regarding data collection, access, disclosure, correction, and other
issues, inquiries may be made to the NEGROS OCCIDENTAL AREA V ATHLETIC
ASSOCIATIONS’ Compliance Team to the Data Privacy Act of 2012 through its Chairman,
JulynS. Dela Cruz at this number 0945 - 9888362.

In consideration of the foregoing, I hereby authorize the NEGROS OCCIDENTAL

AREA V ATHLETIC ASSOCIATION to collect, use, and process the above-specified personal
information for screening, qualification, participation in athletic activities, athletic practices and
training, and publication of results in athletic activities and competitions.

By affixing my signature in this form, I hereby attest that I agree with the aforementioned
conditions.

Date: _____________________

FRANCISCO S. BRAVO III

Signature above printed name of the coach/
asst. coach/chaperon

(NB: This should be attached in the front cover of the coach’s records.)