2017 - 2018

Please fill one form out for each child.

I, the parent/legal guardian of, ____________________________________, grant my expressed permission for Saint Raphael Catholic School to exhibit photographs or likenesses of the above-named student.  No names will be published except in the school yearbook and/or classroom end of the year publications.

(Please initial to indicate permission or refusal.)

Yes_____ No_____ School publications (school newspaper, yearbook, principal’s newsletter,

photo albums,  etc.)

Yes_____ No_____ Yearbook (student picture and name, class pictures)

Yes_____ No_____ Press/media releases (newspaper articles/features, fundraising brochures,

school profile, etc.)

Yes_____ No_____ The Saint Raphael Catholic School website (photos only,

                        no student names will be included.)

By signing this release, I acknowledge that I hereby release and forever discharge Saint Raphael Catholic School and the Diocese of Raleigh and the trustees, officers, agents, and employees of the School and Diocese from and against any and all claims, damages or suits which may arise from, the use of the Saint Raphael Catholic School publications, press/media releases, or website, including, but not limited to, the exhibition of the above-named student’s photograph or likeness or publication of the student’s name.

Parent Signature_________________________________________________  Date________________

Student Name___________________________________________________ Class  _______________

                       (Please print)

Please sign and return to the school office

by Wednesday, August 23, 2017

Failure to return completed form by August 23, 2017 will result in consent.