ATHLETE DATA PRIVACY NOTICE

AND CONSENT FORM

VERSION NO. REVISION NO. EFFECTIVITY Page 1 of 1 DEPED-6-RSAC01-19

1.0 0.0 DATE:
14 January 2019

The WESTERN VISAYAS REGIONAL ATHLETIC ASSOCIATION engages 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 WESTERN VISAYAS REGIONAL
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 WESTERN VISAYAS REGIONAL ATHLETIC
ASSOCIATIONS’ Compliance Team to the Data Privacy Act of 2012 through its Chairman,
Atty. Alberto L. Verdillo at this number 0926 - 7176962.

In consideration of the foregoing, I hereby authorize the WESTERN VISAYAS

REGIONAL 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.

Date: _____________________

____________________________________________
Signature above printed name of the athlete

With the assistance of:

_____________________________________________________
Signature above printed name of the parent/guardian

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