Media Release Parental Consent Form 25-26 (Form 6 of 10)

MEDIA RELEASE FORM

Form 6 of 10
Dear Parent,

Please be advised that during the year your child may be photographed, videotaped, or interviewed at various school sponsored events. With your consent, the photograph, video or interview may be reproduced and released for use in the media, i.e., newspapers, brochures, videos, television, the Internet, and Miami-Dade County Public Schools websites and social media platforms such as Facebook, Twitter, etc.

Please indicate your preference below.
Student’s Last Name*
Student's First Name*
Student’s ID Number*
Please indicate your preference below.*

Yes: My child's photograph/video/interview MAY be reproduced and released for use in the media.No: My child's photograph/video/interview may NOT be reproduced and released for use in the media.
Parent/Guardian Signature*

Clear
Date

MonthDayYear
Date
CONTACT PERSON @ MAST Academy
SCHOOL NAME
SCHOOL TELEPHONE
Submission Receipt E-Mail
example@example.com
Should be Empty:

MEDIA RELEASE FORM