*** This consent form is meant to be signed by people featured in the entry of the entering student.  For example, the performers that can be seen in a film production entry who are not the film producer (entering student), or people in a photography entry, etc.  Submit with entry of the entering student.

For Use of a Minor’s Image or Voice

I give my permission for my son/daughter, _______________________, to participate in the taping, photographing, or audio recording of an entry in the PTA Reflections® Program. I give consent for my child’s voice and or image to be included in the entry. This entry may be used in perpetuity in connection with the PTA Reflections Program or other PTA, Greater Farmington Film Festival, and Farmington Cultural Arts Division purposes.  I understand that entries may be judged at the local, regional, state, and national level. Entries may be displayed at a school or at another public area, including the Internet.

Name of Student Submitting the Entry

Name of Minor in the entry that is not the Student Submitting the Entry

Printed Name of the Parent/Guardian of the Minor in the entry                        

Signature of the Parent/Guardian of the Minor in the entry                                Date

For Use of an Adult’s Image or Voice

I am 18 years or older and I consent to participate in the taping, photographing, or audio recording of an entry in the PTA Reflections® entry. This entry may be used an unlimited number of times in perpetuity in connection with the PTA Reflections Program or other PTA,  Greater Farmington Film Festival, and Farmington Cultural Arts Division purposes.  I understand that entries may be judged at the local, regional, state, and national level. Entries may be displayed at a school or at another public area, including the Internet.

Name of Student Submitting the Entry

Printed Name of the Adult in the entry                                                Date

Signature of the Adult in the entry                                                Date