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PSHS-00-F-DSA-23-Ver02-Rev0 Photo and Video Release Form
PSHS-00-F-DSA-23-Ver02-Rev0 Photo and Video Release Form
PSHS-00-F-DSA-23-Ver02-Rev0 Photo and Video Release Form
CAMPUS:
and videos(s) in any and all its publications and in all other media during the Science Immersion Program
(SIP). The photograph(s) and video(s) shall exclude anything related to Intellectual Property (IP) works,
the period of the SIP or not more than 6 months from the beginning of my immersion of SIP at
.
(SIP Agency)
As parent or legal guardian, I do hereby give my consent and grant my permission to all of the
foregoing.
In compliance to the Data Privacy Act of 2012, personal information that includes
photo(s)/video(s) submitted by the student shall only be used for Science Immersion Program
(SIP) purposes, and shall not be shared/ transferred without prior written consent of the PSHS
SYSTEM and the data subject. The SIP participating agency further warrants that measures
are in place to prevent the unauthorized use or disclosure of the personal information
submitted. The PSHS SYSTEM upon the request of the participating agency shall also secure
photo/video release form that would cover documentation photos/videos of the SIP activities
and for PSHS System promotional and educational purpose only.
PSHS-00-F-DSA-23-Ver02-Rev0-12/09/23