PARENT’S/GUARDIAN’S CONSENT FORM

Name of Learner:
Date of Birth: Sex:
Parent’s/Guardian’s Name:
Relationship to Learner:
Home Address:
Contact Number/s:
Title of the Activity: Science Laboratory Demonstration Session
Venue: Biology & Chemistry Laboratory, LPU Cavite Date of Activity: May 11/12, 2022

As the parent/guardian of the abovementioned learner, I hereby acknowledge that I

have been informed of the details of the in-person activity and voluntarily and freely elect to
participate in this in-person activity. Furthermore, I understand the risks associated with an
in-person activity and agree that the rules and regulations established for the said activity
are for the safety and security of the participants, and thus agree to instruct my child/ward
to obey them.

Having understood all the aforementioned, I hereby consent to allow my child/ward

to participate, acknowledging all of the foregoing. I am also solely responsible for providing
for transportation and any other expenses for my child/ward’s participation in the activity.

Parent/Guardian’s Name and Signature Date

By affixing my signature on this form, I hereby acknowledge and certify that I have carefully read and understood the Data Privacy
Policy of the Lyceum of the Philippines University (LPU). By providing personal information to LPU, I am confirming that the data is
true and correct. I understand that LPU reserves the right to revise any decision made on the basis of the information I provided
should the information be found untrue or incorrect. I likewise agree that any issue that may arise in connection with the processing
of my personal information will be settled amicably with LPU before resorting to appropriate arbitration or court proceedings within
the Philippine jurisdiction. Finally, I am providing my voluntary consent and authorization to LPU and its duly authorized
representatives to lawfully process personal data.