Teacher Publicity Consent Form
Please review and complete this form to provide your consent for publicity purposes related to school or district communications.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
School or Organization
*
Position/Role
*
I consent to the use of my photograph for publicity purposes.
*
Yes
No
I consent to the use of video recordings of me for publicity purposes.
*
Yes
No
I consent to the use of audio recordings of me for publicity purposes.
*
Yes
No
I consent to the use of my name and professional details in publicity materials.
*
Yes
No
Additional Comments or Limitations (optional)
Signature
*
Submit Consent
Submit Consent
Should be Empty: