Publications, Video, Internet Consent And Release Agreement printable pdf download

Publications, Video, Internet Consent And Release Agreement

The San Diego County Office of Education

Publications, Video, Internet Consent and Release Agreement

In order to guarantee student privacy and ensure your agreement for your student to be

recorded by any form of media (photo, video tape, digital recording, etc.), you and your

student must sign and return the form below.

Agreement

I, the undersigned, do hereby give consent to the San Diego County Office of Education

and San Diego County and Imperial Valley Chapter of CAROCP, its organizers and

contributing agents, to use my student’s name, picture, art, written work, voice, verbal

statements or portraits (video or still) in any and all media (print or electronic form),

exclusively for the purpose of public relations, public information, school or district

promotion, publicity, and instruction.

I understand that my student’s name and identity may be revealed therein or by

descriptive text or commentary.

I further understand that there will be no financial or other remuneration for the recording

of my student.

Student’s Name: _________________________________

(print name)

_________________________________

(student’s signature)

Parent/Guardian Name: __________________________________________

(print name)

__________________________________________

(Parent/Guardian signature)

Date Signed: ___________________________________________

The Student and Parent/Guardian may rescind this agreement at any time with written notice.

San Diego County Office of Education

Media Release Form

Oct. 2013

Publications, Video, Internet Consent And Release Agreement