Miami-Dade County Public Schools Media Release Parental Consent Form

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Clear Form
 
MIAMI-DADE COUNTY PUBLIC SCHOOLS
MEDIA RELEASE PARENTAL CONSENT FORM
_______________________
(Date)
Dear Parent:
Please be advised that during the year your child may be photographed, videotaped, or
interviewed at various school sponsored events. With your consent, the photograph,
video or interview may be reproduced and released for use in the media, i.e.,
newspapers, brochures, videos, television, the internet, and Miami-Dade County Public
Schools websites and social media platforms such as Facebook, Twitter, etc.
Please indicate your preference below.
 
________________________________
________________________________
(Student’s Name)
(Student’s ID)
Yes.
My child's photograph/video/interview may be reproduced and
released for use in the media.
No.
My child's photograph/video/interview may not be reproduced and
released for use in the media.
_______________________________
_______________________
(Signature)
(Date)
Return this signed form to:
CONTACT PERSON: ____________________________________________________
SCHOOL NAME: _______________________________________________________
SCHOOL TELEPHONE: __________________________________________________
FM-7489E Rev. (05-16)

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