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ATHLETE DATA PRIVACY NOTICE AND CONSENT FORM

The Department of Education engages in the collection of personal


information such as the full name, address, age, medical and dental
records, photographs, Learner Reference Number, school records,
parental information, and contact information of its student athletes.

All personal information collected by the Department shall be


utilized for accounting, auditing, screening, qualifying, performance
monitoring, and other legitimate purposes for the conduct of athletic
meets, sports competitions, practices, and the publication of results of
sports activities and competitions.

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 compliance
officer for privacy, (specify school head, schools division superintendent,
regional director) at (specify email address and contact number).

In consideration of the foregoing, I hereby auhorize the Department


of Education 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. In the course of my application to
participate in school, division, regional, national, and international
activities and competitions, I hereby authorize the Department of
Education to transmit relevant personal information to authorized
Department personnel to process such application.

I am hereby authorizing the Department of Education to collect,


process, retain, and dispose of my personal information in accordance
with Department policies.

Date: ________________________

_____________________________________
Signature above printed name
Student-athlete

_________________________________ ______________________________
Signature above printed name Signature above printed name
Parent/Guardian Parent/Guardian

Witnessed by:

________________________________
Signature above printed name
Teacher/Coach
COACH DATA PRIVACY NOTICE AND CONSENT FORM

The Department of Education engages in the collection of personal


information such as the full name, address, age, medical records,
photographs, educational and training qualification, and contact
information of its coaches.

All personal information collected by the Department shall be


utilized for accounting, auditing, screening, qualifying, performance
monitoring, and other legitimate purposes for the conduct of athletic
meets, sports competitions, practices, and the publication of results of
sports activities and competitions.

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 compliance
officer for privacy, (specify school head, schools division superintendent,
regional director) at (specify email address and contact number).

In consideration of the foregoing, I hereby auhorize the Department


of Education 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. In the course of my application to
participate in school, division, regional, national, and international
activities and competitions, I hereby authorize the Department of
Education to transmit relevant personal information to authorized
Department personnel to process such application.

I am hereby authorizing the Department of Education to collect,


process, retain, and dispose of my personal information in accordance
with Department policies.

Date: ________________________

_____________________________________
Signature above printed name
Coach
CONFIDENTIALITY UNDERTAKING

I, ( name ), ( designation ) of ( office ),( agency ),


hereby understand that highly confidential information is being collected
and processed from the conduct of the athletic activities and
competitions within the Department of Education. I hereby affirm that I
am authorized and designated to handle and control the said information
in confidence.

In this regard, any information gathered and processed will be kept


confidential and will not be disclosed, divulged nor used beyond its
intended purpose. It may not be reproduced in whole, or in part, nor may
any of the information contained therein be disclosed without the prior
notification or consent of the data subject concerned nor of the
Department of Education.

Furthermore, I acknowledge that the illegal and or unauthorized


disclosure or use of information collected and processed shall be subject
to administrative and criminal liability under the law.

___________________________________
SIGNATURE OVER PRINTED NAME
SECURITY CLEARANCE

I hereby certify that the following personnel indicated below are


authorized to collect, process, retain, and dispose of personal information
of learners in accordance with the Data Privacy processes and policies of
the Department of Education:

NAME DESIGNATION TYPES OF PERIOD OF SIGNATURE


DOCUMENTS OR VALIDITY
PERSONAL OF
INFORMATION SECURITY
CLEARANCE

All learner records are highly confidential pursuant to the


provisions of BP 232 and other relevant laws, rules, and regulations.
Only the designated personnel may handle these personal information
within the period of validity of their security clearance.

_________________________________________
(Head of School/Division/Regional Office)
Signature Above Printed Name

Name of School:________________________
Division: _______________________________
Region: ________________________________