MDCPS - 24 -25 Media Release (Eng.)

MIAMI-DADE COUNTY PUBLIC SCHOOLS MEDIA RELEASE PARENTAL CONSENT FORM
Physical Education and Health Literacy
(Date)*

MonthDayYear
Date
Please be advised that during the year your child may be photographed, video taped or interviewed at various school sponsored events. With your consent, the photograph, video or interview may be reproduced and released for use by the media, i.e., newspapers, brochures, videos, television and through the internet.
Please indicate your preference below.*

Yes.No.
(Student's Name)*
My child's photograph/video/interview may be reproduced and released for
My child's photograph/video/interview may not be reproduced and released
(Signature)*

Clear
(Date)*

MonthDayYear
Date
CONTACT PERSON*
SCHOOL NAME*
SCHOOL TELEPHONE*
Should be Empty:

Physical Education and Health Literacy