[SCHOOL OR PROGRAM NAME]
Photo and Media Permission Form
[School or program name] takes photos and video of students during classes and events. Please choose how your child's image and work may be used, then sign and return this form to [name or office] by [Month DD, YYYY].
Student name Grade / class
Teacher School year
USE | YES | NO |
|---|---|---|
School yearbook | □ | □ |
Classroom and hallway displays | □ | □ |
Printed school newsletter | □ | □ |
School website | □ | □ |
School social media accounts | □ | □ |
Local news media covering school events | □ | □ |
Video recordings of performances and events | □ | □ |
Student's first name shown with a photo | □ | □ |
The school will not publish a student's full name, address, or contact details with a photo. This permission lasts for the school year above. You can change it at any time by notifying [name or office] in writing.
Parent / guardian name Phone
Parent / guardian signature Date