Photo and Video Waiver
Please check one:
I give Mentorship Academy TRIO Programs and/or Mentorship Academy staff permission to photograph and/or videotape my child (named below) participating in TRIO Programs and/or Mentorship Academy activities for archival and promotional purposes. I understand that these photographs and/or videos may be used in program publications or other media during the full length of participation in TRIO Programs and for indefinitely after graduation.
I do not give permission for my child (named below) to be photographed or videotaped for promotional purposes. I understand that this does not apply to still photographs required for Mentorship Academy and/or TRIO Programs related ID cards or confidential records.
This waiver is active until a new waiver is submitted from the parent or
student of consenting age.
Name of student
First Name
Last Name
Name of parent/guardian
First Name
Last Name
Signature of parent/guardian
Date
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: