Little Tot's Learning Daycare, II Photo & Video Release Form

Little Tot's Learning Daycare, II Photo & Video Release Form

1028 Schuman Place, Baldwin, NY 11510 Tel# 516-246-1199
Date:

MonthDayYear
Date
I give permission for Little Tot's Learning Daycare, II ("Provider") to photograph and/or video record my child during daycare activities, field trips, special events, and classroom routines, both on and off the daycare premises.
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Child(ren) Covered by This Authorization

Please list all children covered by this authorization.
Child #1 Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Child #2 Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Child #3 Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Child #4 Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Permission to Use Photos and Videos

I, the undersigned, hereby grant Little Tot's Learning Daycare, II the absolute right and permission to photograph, video record, use, reproduce, publish, display, distribute, and share my child(ren)'s image, likeness, voice, photographs, videos, and other media for any lawful business, educational, promotional, marketing, advertising, informational, or program-related purpose, including but not limited to:

• Educational materials

• Publications and newsletters

• Advertising and promotional materials

• Social media platforms

• Websites

• Press releases

• Brochures, flyers, and marketing materials

• Digital, electronic, and printed media

• Presentations and displays

• Any other lawful business or program-related purpose
Voluntary Consent
Use of Child's Name
No Compensation
Release and Waiver

I release and discharge Little Tot's Learning Daycare, II, its owners, employees, agents, and representatives from any claims arising from the authorized use of my child(ren)'s photographs, videos, likeness, voice, or other media, including claims for defamation, invasion of privacy, or violation of publicity rights.
Revocation of Consent

I understand that I may revoke this consent at any time by providing written notice to the Provider. Revocation will apply only to media created after the Provider receives the notice. Previously published or distributed media may continue to be used.
Signature Acknowledgment

By signing below, I certify that I have read, understand, and voluntarily agree to the terms of this Photo & Video Release Form.
Parent/Guardian Signature
Date Signed:

MonthDayYear
Date
Should be Empty:

Little Tot's Learning Daycare, II Photo & Video Release Form

Child(ren) Covered by This Authorization