Media Release Permission Form
Student's Full Name
*
First Name
Last Name
School Name
*
Teacher Email
*
Teachers will receive a copy of this form for their records.
Caregiver's Full Name
*
First Name
Last Name
Caregiver's Email
*
You will receive a copy of this completed form to your email
Consent for Media Release
*
I grant permission to use my child's, voice, and/or likeness for promotional purposes.
Caregiver's Signature
*
Date
*
/
Day
/
Month
Year
Date
Submit
Should be Empty: