Consent To Release Photo/image Release Form printable pdf download

New Hanover County Schools

CONSENT TO RELEASE PHOTO/IMAGE

Dear Parent/Guardian:

During the current school year, your child’s image/photograph or work may be included in a classroom or

school project that could be used in one of the following ways:

¾ Used as a demonstration project/activity in education workshops/classes/conferences

¾ Used as a sample project/activity on CD’s created by New Hanover County for use in education

workshops and student classrooms

¾ Posted on the school or NHCS web pages on the Internet

¾ Submitted as samples to program publishers or as contest entries to sponsors

¾ Appear on videotape made during a student presentation of their project, or in broadcasts or

videotapes demonstrating computer multimedia in general

¾ Videotaped to appear in a school related program to be used by a local television station or

school/county project

¾ Used in a printed publication such as a newspaper or magazine

While your child’s name may accompany the photo, no last name or address will be included with your

child’s picture when publishing on the Web.

There is no monetary compensation for the use of the work, but it will help many teachers get more use

out of their computers, and show other students a good example of what can be. Please sign the release

form below and return this sheet to your child’s school. Your permission grants us approval to publicize

without prior notification and remains in effect until revoked. Thanks!

Release Form

________I/We DO give permission for __________________________________________’s

Child’s full name

image/photograph or work to be used a described above. We are willing to release this into the public

domain and understand that no monetary compensation will be given for the use of the materials.

________I/We DO NOT give permission for _______________________________________’s

Child’s full name

image/photograph or work to be used a described above.

Parent/Guardian Name_________________________________________________________

Please print clearly

Parent/Guardian Signature ______________________________________________________

Address_____________________________________________________________________

City, State, Zip Code___________________________________________________________

Phone Number_________________________

Date_________________________________

Please return this form to your child’s teacher.

DATE

_______________________________________________________________________

A-8

Consent To Release Photo/image Release Form