School Website Image Consent Form
Please complete this form to provide or withhold consent for the use of your child's image on the school's website.
Student's Full Name
*
First Name
Last Name
Student's Grade/Class
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
Parent/Guardian's Full Name
*
First Name
Last Name
Relationship to Student
*
Please Select
Mother
Father
Legal Guardian
Other
Parent/Guardian's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian's Email Address
*
example@example.com
Are there any restrictions or special instructions regarding the use of your child's image? (Optional)
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Signature
*
Submit Consent
Submit Consent
Should be Empty: