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Photo Consent Form

-2020 CONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE A STUDENT

FOR EDUCATIONAL/NON-PROFIT USE

(e.g. educational, public service, or health awareness purposes)

Parent/Guardian Name:*

Answer required for "Parent/Guardian Name:"

Parent/Guardian Number:*

Answer required for "Parent/Guardian Number:"

Student Name:*

Answer required for "Student Name:"

Consent

Answer required for "Consent"

By checking this field, I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the Student named above by Middle School of Media, Law & Fine Arts. I also grant to the right to edit, use, and reuse said products for educational and non-profit purposes including use in print, on the internet, and all other forms of media. I also hereby release the New York City Department of Education and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

Confirmation Email

Answer required for "Confirmation Email"