Churchill Junior High School PTA Media Release
I grant to Churchill Junior High School PTA, National PTA, and their representatives and employees the right to take or use photographs and/or video of me and my family in connection with this PTA Program without further compensation and without the need for any further consent from me. I authorize Churchill Junior High School PTA, National PTA, their assignees, and transferees to use and publish the same in print and/or electronically.
I agree that Churchill Junior High School PTA and National PTA may use such photographs or videos of me and my family with or without my name for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and web content.
I have read and understand the above.
Signature:
Printed Name:
Student First & Last Name:
Grade for the 2026-2027 School Year:
Date:
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Day
Year
2 digit month, 2 digit day, 4 digit year
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