Student Media Release Form
Student Name
First Name
Last Name
School Name
Grade
Please Select
Kindergarden
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
1
I agree that I give my child permission to appear in videos, audio recordings, films, photographs, written articles, and on websites and social media sites.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent Name
First Name
Last Name
Parent Signature
Submit
Should be Empty: