Youth Protection · Rotary District 3860

Minor Media Consent Form

Parent or guardian permission for photos and videos of minors at Rotary service projects. Fill it in here, sign on screen, and download the completed PDF.

For club project organizers

Fill in the project details below, then copy a link to send to parents so they only need to complete their child's details. Prefer paper? Download the form with your project details printed on it, or completely blank.

Your answers stay on your device. The PDF is created in your browser and nothing you type is sent to or stored by this website. After downloading, send the PDF to the Rotary club running the project, or print it and hand it to them.

We love celebrating our community impact! Rotary regularly documents our service projects through photography and video to share on our official district/club websites, social media accounts, and print newsletters.

In compliance with the Philippine Data Privacy Act of 2012 (Republic Act No. 10173), as well as Department of Education (DepEd) child protection guidelines (for school-based activities) and local community child protection protocols, we require your written permission before publishing any images featuring your child.

Project details

Rotary Club of

Name of service project

Date & venue of event

Beneficiary / minor information

Full name of minor*

Barangay / community residence

School name & grade level (if applicable)

Name of parent / legal guardian*

Mobile / contact number

Parent / legal guardian authorization

Please read the choices below carefully and tick the appropriate box. Declining consent will NOT prevent your child from participating in the service project, nor will it disqualify them from receiving any goods, donations, or benefits from Rotary.

Signature

Sign below, or leave it blank and sign the printed copy by hand.

Sign here with your finger or mouse

Date signed

Data Privacy Notice: The personal information collected on this form is processed solely for accountability, compliance verification, and documentation tracking by Rotary. In compliance with the Philippine Data Privacy Act of 2012, all information provided will remain secure, private, and confidential. It will not be sold, shared, or repurposed for any commercial marketing activities.