School Media Release Form
Student Name
First Name
Last Name
The student is
Younger than 18
18 or older
Parent Name
First Name
Last Name
I, undersigned, agree with the selected statement:
I grant permission the student to participate and appear in video or audio recording, films, photographs, written articles, or on websites and social media sites.
I do not consent to use of the student's photograph, voice, and/​or name in various media projects.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent Signature
Student Signature
Submit
Should be Empty: