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CONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE A STUDENT FOR NON-PROFIT USE (e.g. educational, public service, or health awareness purposes)

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Please complete the form below. Required fields marked with an asterisk *

Student's FIRST Name*

Answer Required

I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or videotapes of the student named above.

I also grant the school the right to edit, use, and reuse said products for nonprofit purposes including use in print, on the internet, and all other forms of media. I also hereby release the New York City Department of Education and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

Parent/Guardian FIRST Name*

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Homeroom/Advisory Teacher*

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What event are these images/videos from (ex. Kindergarten Zoo Field Trip, 2020 Spring Gala, PTA Bake Sale, etc...)*

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Date Consent Given*

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Upload images, media, and/or files you would like us to add to the website (no guarantees)

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Choose a file or drag it here.