Media Consent Form And Release printable pdf download

CHICAGO PUBLIC SCHOOLS

MEDIA CONSENT FORM AND RELEASE

School ______________________

Date ________________________

I hereby consent to have __________________________________

(full name and relation)

photographed, video taped, audio taped or interviewed by the Board of Education of the

City of Chicago (the "Board") or the news media when school is in session or when my

child is under the supervision of the Board. I understand in the course of the above

described activities that the Board might like to celebrate my child’s accomplishments

and work. Therefore, I further consent for the Board’s release of information on my

child’s name, academic/non-academic awards and information concerning my child’s

participation in school-sponsored activities, organizations and athletics.

I also consent to the Board’s use of my child's name, photograph or likeness,

voice or creative work(s) on the Internet or on a CD or any other electronic/digital media

or print media.

As the child's parent or legal guardian, I agree to release and hold harmless the

Board, its members, trustees, agents, officers, contractors, volunteers and employees

from and against any and all claims, demands, actions, complaints, suits or other forms

of liability that shall arise out of or by reason of, or be caused by the use of my child's

name, photograph or likeness, voice or creative work(s),on television, radio or motion

pictures, or in the print medium, or on the Internet or any other electronic/digital medium.

It is further understood and I do agree that no monies or other consideration in

any form, including reimbursement for any expenses incurred by me or my child, will

become due to me, my child, our heirs, agents, or assigns at any time because of my

child's participation in any of the above activities or the above-described use of my

child's name, photograph or likeness, voice or creative work(s).

I understand that I may cancel my consent by providing written notice to the

principal.

_________________________________________________

Signature of Parent or Guardian or Student if age 18 or over

____ I do not consent to my child being photographed, video taped, audio taped and/or

interviewed by the Board or the news media when school is in session or when my child

is under the supervision of the Board. I do not consent for the Board to use creative

work(s) generated and/or authored by my child on television, radio or motion pictures, or

in the print medium, or on the Internet or any other electronic/digital medium.

_________________________________________________

Signature of Parent or Guardian or Student if age18 or over

Media Consent Form And Release