TGS Yearbook Name and Image Waiver

TGS Yearbook Name and Image Waiver
By offering your consent, you permit The Grace School to produce, publish, and disseminate a school yearbook with identifying information about your child including, but not limited to, the following:

a) photos/images of your student

b) student work samples

c) your student's name

If you consent, then authorization is valid from the date of your signature. You have the right to revoke this authorization by providing written notice to The Grace School. However, this authorization may not be revoked if The Grace School, it’s employees or agents have taken action on this authorization prior to receiving my written notice.

This authorization is voluntary and may be refused. Your refusal will not affect eligibility for benefits, enrollment in educational services, provisions for therapy care, or payments.
Do you consent to the terms in this Name and Image Yearbook Waiver?

YES, I consent to the terms of this waiver.NO. I do not agree to the terms of this waiver.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
My Student's Name and Date of Birth
Should be Empty: