Career Tech Academy
Photo Consent Form
I agree to and authorize the use and reproduction by employees of the Southern Virginia Higher Education Center (SVHEC), of pictures, photos, video tape film, audio tape, or digital or electronic media taken of me by any employee of SVHEC, or provided to any employee of SVHEC by a third party, for any purpose whatsoever without compensation to me. I acknowledge and agree that all such media, including digital and physical images, negatives, positives, and any other material, belong to SVHEC and may be used only in connection with the promotion of SVHEC. As of the date of endorsement of this release, I relinquish all rights to and control over any pictures, photos, videotape film, audio tape, or digital or electronic media taken of me by any employee of SVHEC, or provided to any employee of SVHEC by a third party. I further understand that I may revoke my authorization to use and reproduce the media described above by submitting a request in writing to SVHEC.
Date
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Month
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Day
Year
Date
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Parent's Name
First Name
Last Name
Student's Name
First Name
Last Name
Parent Signature
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