2021 Student Media Consent and Release Form

Student Media Consent and Release Form
Throughout the school year, students may be highlighted in efforts to promote HISD activities and achievements. For example, students may be featured in materials to train teachers and/or increase public awareness of our schools through newspapers, radio, TV, the web, DVDs, displays, brochures, and other types of media. I, as the parent or guardian of Student Name* , hereby give HISD and its employees, representatives, and authorized media organizations permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital and printed media field.
A. This is with the understanding that neither HISD nor its representatives will reproduce said photograph, interview, or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. I am also fully aware that I will not receive monetary compensation for my child’s participation.

B. I further release and relieve HISD, its Board of Trustees, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material. I certify that I have read the Media Consent and Release Liability statement and fully understand its terms and conditions.

I certify that I have read the Media Consent and Release Liability statement and fully understand its terms and conditions.
Name of Child *

First Name Last Name
Grade *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent or Gradian Signature *

Clear
Date *

Month Day Year
Date
Phone Number *
Please enter a valid phone number.
Should be Empty: