Consent for Photograph

Child's Name*

First NameLast Name

At times we photograph students/residents in the program including our Camp Haven summer program, and at our Learning Center. We use these photos as identified below. Please sign initials below for the ways your permit us to use your student’s/resident’s photograph.

I approve the use of the above identified child's photograph for:*

Projects shown only to Brookhaven staffProjects shown on campus (and during on campus events)No photos of my student may be used other than a headshot for safety purposes and identification.IF YOU CHOOSE THIS **Please understand this can be upsetting to the child as they want to have their picture displayed with other children’s. We are trying to increase normalcy for them so if it is not a safety issue please allow them to experience the pride they feel when their picture is celebrated.

If selected "no photos" above, please provide explanation for their file record

Parent/Legal Guardian Signature*

Parent/Legal Guardian Name*

First NameLast Name