Healthy Lungs, Healthy India - Sign up for Asthma Screening Form

Consent Form of Parent/Legal Guardian

Please read the consent form carefully and for any queries kindly reach out to the school staff for further information. This form must be fully read, understood, and signed by the parent/legal guardian to allow the student to participate in the Tuffies Initiative details of which have been informed to me by the School and provided below to be conducted by Cipla Limited (‘Cipla’) in association with Indian Association of Pediatrics for spreading awareness on Asthma Awareness.

Tuffies Initiative consists of the following:

• Online / offline Asthma Screening - Preliminary examination will be conducted through the online or offline test in the form of a questionnaire to be filled out by the parents based on the child’s health and symptoms.
• Lung Health screening score report will be shared with the parents. Anonymized data of lung health screening results that may be taken during the activities or camps held in the school premises shall be used by Cipla Limited for research paper and study conducted by Cipla in association with Indian Academy of Pediatrics in accordance with applicable laws. The same may be used on Cipla’s and/or its affiliate’s websites and/or on digital, social media and offline platforms. I understand that Cipla may engage third-party service providers for organizing and conducting the Tuffies Initiative.
• In-school activity: Encouraging participation of students from standard 2nd to 7th all divisions. Here the students will be shown Tuffies animation clip for introduction of Tuffies characters and message for students to be strong and unstoppable like the Tuffies characters.

1. I hereby consent for my child’s enrolment and participation in the Tuffies Initiative including the Lung Health Screening Test by filling the online or offline screening form. Based on the inputs provided by me in the form and the results generated therefrom, Cipla disclaims all liabilities arising from any incorrect and inaccurate information provided by me in the online/offline form.
2. I understand and acknowledge that the Tuffies Initiative aims at spreading awareness on lung health and respiratory diseases and the same should not be a substitute for obtaining medical advice from a licensed health care practitioner. I further understand that the Asthma Screening is a limited summary based on the score results and is not meant to be comprehensive and should not be a substitute for obtaining medical advice, treatment and diagnosis from a licensed and qualified healthcare professional. For any specific health-related concerns or queries, and before starting with any medication or treatment for my child a qualified healthcare practitioner should be consulted. I understand that this initiative is not an endorsement for any treatment, medication or promotion of any medical product or device.
3. I understand that any intellectual property of Cipla including any trademark or Cipla tradename shall not be used without the prior written consent of Cipla.
4. I understand that photographs and videos of my child may be taken to document the activities and I hereby give my permission for photographs and/or videos to be taken of my child / anonymized data of lung health screening results that may be taken during the activities or camps held in the school premises shall be used by Cipla Limited for research paper and study conducted by Cipla in association with Indian Academy of Pediatrics in accordance with applicable laws. The same may be used on Cipla’s and/or its affiliate’s websites and/or on digital, social media and offline platforms. I understand that Cipla may engage third-party service providers for organizing and conducting the Tuffies Initiative.
5. I understand that my child’s data such as name, photograph, Lung Health screening score shall be collected and processed by Cipla’s authorised service provider and I hereby grant my consent to use my Child’s name, image and anonymised data of lung health screening score solely for research purpose in relation to the Tuffies Initiative in manner set out in this consent form as agreed in the clause iii) above of this consent form. Further my name, email id and phone number can be used to further notify/intimate me about any occurrences arising out of and relating to using my Child’s personal data. Name, image, email id and phone number collectively referred to as (‘Personal Information’). I understand that Cipla will be responsible and liable for protecting Personal Information against misuse by third-party service providers under applicable laws.

Privacy Notice

(Please read this Privacy Notice carefully before signing the Consent Letter)

Introduction
Cipla Limited including its affiliates or subsidiaries (hereafter referred to as “Cipla”, “we”, “our” or "us") respects your privacy and is committed to protecting your Personal Data. In this Privacy Notice “You” or “Your” refers to Data Principal whose Personal Data is collected and processed by us.

Purpose of this notice
This Privacy Notice will explain how we will collect and use your child’s Personal Data (defined hereinbelow) taken during your interaction with the company or its employees/affiliates (hereinafter referred to as “Engagement”). This notice is also to apprise you of your rights and the grievance mechanism available to you in relation to your Personal Data.

What Data will be collected and how will it be used?
On providing the below consent, Cipla or its authorized service providers may collect your personally identifiable data in the due course of your engagement with us in relation to Tuffies Ki School Yatra (referred to as “Program”), including but not limited to your name, age, gender, marital status, email id, mobile number, photo identity proof, address proof, photographs & video clips showcasing you during such engagement (collectively referred to as “Personal Data”), and such would be used for Research & Study. Cipla may share your Personal Data with third-party service providers for editing the photographs for aesthetic and/or visual purposes and/or for broadcasting or printing the same.

What are your data protection rights?
You can request access to the information we process about you at any time. If at any point you believe that the Personal Data that we process, relating to you, is incorrect or not updated, you can request to see this information and have it corrected, restricted, or erased. You also have the right to withdraw your consent at any time.

Grievance mechanism
If you wish to raise a complaint on how we have handled your personal data, including any queries on collection, storage, processing, use, protection, deletion and retention of personal data, details relating to third-party service providers involved, with whom the data is being/ will be shared, can be obtained by writing to us at globalprivacy@cipla.com and any grievances or complaints for correction and updating of your personal data can be obtained by writing to ethics@cipla.com.
If you are not satisfied with our response or believe we are not processing your personal data in accordance with the applicable laws, you can raise a complaint with the appropriate authority as prescribed and notified under applicable laws.

I the undersigned do hereby state as follows:

1. I confirm that I have read and fully understood the contents of this Privacy Notice and I hereby consent to recording, collecting, storing, processing, sharing and using of my child’s personal data keeping it anonymous in relation to Research & Study for purposes mentioned in this Privacy Notice and Tuffies initiative.
2. I understand that my personal data will be used only in the manner specified hereinabove and my name and email id, mobile number, will be used for any further notice and communication with me, arising out of/ relating to use of my personal data.
3. I have been informed and notified of my rights to correct, delete, erase my personal data or withdraw my consent at any time.
4. I agree and accept that this consent provided by me is voluntary and is not subject to any terms and conditions, commercial or otherwise.
5. The contents of the Privacy Notice, this Consent Form and the rights available to me are fully understood by me and accordingly accepted by me.