Consent Form Sample

DPO-001-18-0
Valenzuela City + Quezon City + Antipolo City + City of San Fernando + NEDCI
CONSENT AND AUTHORIZATION FORM

The Our Lady of Fatima University respects a person’s right to privacy and the confidentiality of his/her personal
information. By signing, you acknowledge that you have read the Consent and Authorization Form in full and agree to be
bound by and comply with them. Agreement to all these provisions below is a condition to admission to the Our Lady of
Fatima University.
By signing below, I agree

with the following:
1. I hereby certify that I have accomplished the application form truthfully and to the best of my knowledge. All data
provided are accurate and updated, and that I submit myself to the University’s administrative and disciplinary
sections should there be a ny discrepancies or false information in my application and in the documents submitted.
2. I shall abide by all the regulations and policies promulgated by Our Lady of Fatima University as stated in the OLFU
handbook and in the college and/or department policies.
3. I understand and accept that Our Lady of Fatima University does not recognize any sorority and fraternity, and that
initiation activities (hazing, etc.) are strictly prohibited inside and outside of school premises. Any student participating in
such activities may be excluded from the University.
4. The university conducts random drug testing as part of its advocacy in keeping a drug-free and safe academic
environment. As a student, I may be randomly selected to undergo drug testing at any time. I hereby give my consent to
participate in the random drug testing program of the University following accepted protocols. I release Our Lady of
Fatima University from any liabilities, claims and causes of action, known or unknown, contingent or fixed, that may
result from these tests.
5. I hereby authorize and give voluntary consent to Our Lady of Fatima University to collect and process the information
stated herein, and other personal and academic information as required by the University or as deemed necessary.
These may include, but not limited to, information pertaining to my academic performance, my personal information, my
socio-economic profile, and other sensitive information that might be needed or academic evaluation & monitoring,
scholarship grants, financial aid, ethical or disciplinary proceedings, research, statistical reports, and medical evaluation.
6. I hereby give my authorization to the University to process these information according to the policies of the University
and to release such data to any third party to which the University deems necessary for any legal purpose for the
furtherance of my academic, professional and personal development ( such as but not limited to practicum and
affiliation partners, possible recruitment a nd placement offices, institutional partners, research centers and other such
private and government agencies). I likewise give my consent to the University to release my academic and non-
academic status to my parents and guardians as named in the application form. I agree to the University practice of
posting academic performance as needed.
7. I agree, authorize and give my consent to Our Lady of Fatima University to use images and recordings in school
activities where I participated without expectation of compensation or other remuneration. This consent is given in
perpetuity, and does not require my prior approval.
8. I agree to all the terms and conditions stated herein and to all the policies of Our Lady of Fatima University and that my
agreement to all those stated above is among the conditions to my enrollment at the Our Lady of Fatima University.
9. That together with the Consent/Authorization Form, I have read and agreed to the Terms of Agreement of OLFU Data
Privacy Policy embodied in the Student Handbook and Application Form which complies with the Data Privacy Act (DPA)
of 2012.
Note: Please affix your signature over your

printed name.
Student’s Signature Father’s Signature Mother’s Signature Guardian’s Signature

DPO-001-18-0
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DPO-001-18-0

CONSENT AND AUTHORIZATION FORM

By signing below, I agree

Note: Please affix your signature over your

Student’s Signature Father’s Signature Mother’s Signature Guardian’s Signature

Date Date Date Date

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