Educational Institution Showcase Consent Form
Provide your consent for the use of your information and media in school showcases and promotional materials.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Institution
*
Student
Parent/Guardian
Staff/Faculty
Other
Grade or Department
*
Name of Showcase/Event
*
Types of Media Consent
*
Photographs
Video Recordings
Audio Recordings
Student/Staff Work Samples
Name and Achievements
Other
Preferred Method of Contact
Email
Phone
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Additional Comments or Restrictions (please specify any limitations to your consent)
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
Should be Empty: