Parent/Guardian Publicity Authorization and Release Form

Parent/Guardian Publicity Authorization and Release Form
Please take note of the following:
- By this form, the educational service/company requests your permission to reproduce through printed, audio, visual, or electronic means activities in which your student has participated in his/her education program. Your authorization will enable us to use specially prepared materials to increase public awareness and promote continuation and improvement of our programs through the use of mass media, newsprint, displays, brochures, websites, etc.
- Parent/Guardian must submit this Parent/Guardian Publicity Authorization and Release Form if the student is under 18 years of age.
Student name
First NameLast Name
Date of birth
MonthDayYear
Date
By signing below I agree the following:
I, as a parent or guardian of the above-named student, fully authorize and grant the educational service/company and its authorized representatives the right to print, photograph, record, and edit as desired, the image, likeness, and/or voice of the above-named student on audio, video, film, slide, or any other electronic and printed formats, currently developed, (known as “Recordings”), for the purposes stated or related to the above.I understand and agree that use of such Recordings will be without any compensation to the student or the student’s parent or guardian.I understand and agree that the service/company and/or its authorized representatives shall have the unlimited right to use the Recordings for any purposes stated or related to the above.I authorize that the service/company representative is not responsible for injuries inflicted upon participating parties. Client(s) will be responsible for their children and release the representative from any claims against their person or business.
My signature shows that I have read and understood the release, and I agree to accept its provisions.
Parent/guardian name
First NameLast Name
Parent/guardian email
example@example.com
Parent/guardian phone number
Please enter a valid phone number.
Signature
Clear
Should be Empty: