DATA PRIVACY CONSENT FORM

In compliance with the Data Privacy Act (DPA) of 2012, and its Implementing Rules and Regulations (IRR) effective since
September 8, 2016, I allow my Instructor (PFIT001) to provide me certain services declared in relation to Physical Activvity
Towards Health and Fitness. As such, I agree and authorize:

1. On – site documentation of our class activity performed and even in the community or any other safe space and
area.

2. Retain my information/data for a period of five years I agree that my information will be deleted/destroyed after this
period.

3. Share my information to other classes as sample for the sake of presentation and necessary third parties for any
legitimate educational purpose.

4. I am assured that security systems are employed to protect my information.

5. I was well oriented that class beadle shall keep record in checking/monitoring of class attendance for online and on
site.

6. Utilize my photos to be posted in other educational platforms as part of our engagement in the subject processes. I
also acknowledge and warrant that I have acquired the consent from all parties relevant to this consent and hold
free and harmless and indemnify Subject Instructor from any complaint, suit, or damages which any party may file
or claim in relation to my consent.

7. I understand the blended/hybrid modality where instructors shall utilize online learning resource in the
explanation/presentation of the lesson whilst reporting on site shall be a validation of class
understanding/comprehension of the uploaded materials in the G class through group dynamics/group activities and
performance-based session.

8. I expect an immediate feedback for my performance-based assessment conducted through online/face to face
encounter.

9. I am responsible to read ahead the subject’s topics/lessons and motivate myself for independent learning, submit
on time the necessary requirements, participate in an on-site interactive activities and I am bound with a timeline
and cooperate with the class groupings for classroom management.

Signed this _____day of __________________20___ at _________________________ City.

________________________
Signature over Printed Name
 Parent/Guardian Information Sheet
(This is for monitoring purposes)

Student Name: _________________________ Course/Year: _________________ Class Time: ______________

Name of Father: ________________________ Occupation: ___________________ Contact No. ______________

Name of Mother: _______________________ Occupation: ___________________ Contact No. ______________

Name of Guardian: _____________________ Occupation: ___________________ Contact No. ______________

Address: ________________________________________________

Student’s interests/or issues that I should be aware of:

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

______________________________________ _________________________________________
Student signature and Date Parent/Guardian and Date