Media Release Form

Media Release Form
Images, videos, and other forms of media enable the Lake Washington Schools Foundation to connect with the community. This release permits usage of you and/or your child’s photos, videos, and other forms of media in various forms through publications and materials that may include but are not limited to: social media, printed and/or electronic communications, within 10 years from the date this form is signed.

Please submit one form per participant.
Date*

MonthDayYear
Date
Name of Participant in photo, video, etc.*

First NameLast Name
School (if participant is under 18 years of age)

Agreed and Accepted by
I hereby authorize LAKE WASHINGTON SCHOOLS FOUNDATION (LWSF) and those acting pursuant to its authority to: (i) record my or my child’s likeness and/or voice on a video, audio, photographic, digital, electronic, or any other medium; (ii) use my or my child’s name and biographical material in connection to any form of media; (iii) use any material or content I provide to LWSF; and (iiii) use, reproduce, exhibit, and/or distribute my or my child’s name, biographical material, recordings and story in any medium (e.g., print publications, video, internet, etc.) for promotional, advertising, educational, and/or other lawful purposes. I release and waive any claims or rights of compensation or ownership regarding such uses and understand that all such media shall remain the property of LWSF.
Attestation of Legal Age

I certify that I am 18 years of age or older, a participant in one or more types of media mentioned above and I authorize the usage of my FIRST AND LAST NAME and likeness as noted in this document.
Attestation of Parent/Guardian

I am the parent or guardian of the participant who is under 18 years of age and who is in one or more types of media mentioned above; and authorize the usage of their FIRST NAME ONLY and likeness as noted in this document.
Authorization for Lake Washington Schools District

I also authorize Lake Washington School District to use mine and/or my child's name and likeness as noted in this document. (optional)
Participant Signature or Parent/Guardian Signature if participant is under 18 years of age.*

Clear
Email*
example@example.com
Phone Number:*

Area CodePhone Number
Should be Empty:

Media Release Form

Agreed and Accepted by