Student Name
*
First Name
Last Name
Grade Level
Parents Name
*
First Name
Last Name
Authorization and Release
What is your preference regarding the use of your child's name?
*
I consent to the use of my child's complete name.
I consent to the use of my child's first name only.
I consent to the use of my child's nickname
I consent to the use of my child's photographs anonymously.
Please check the boxes regarding your preference.
*
I authorize Interact members and advisors to take my child's photographs.
I authorize Interact members and advisors to use my child's photos on Facebook, Twitter, Instagram, and other social media platforms.
I authorize Interact members and advisors to edit, alter, copy, or distribute the photos for social media advertising and marketing.
I agree that the photos all intellectual property rights of the photos belong to Interact.
I agree that I will not receive any monetary compensation for usage of my child's photographs in social media platforms.
Signature
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: