2016-17 Digital & Print Media Permission Agreement
Zion Lutheran Church and School uses photographs, videos/film and sometimes audiotape of our students and staff in a variety of printed and online media, including newsletters, both church and school websites, marketing and admissions materials, fundraising efforts, the church & school's official social media outlets and media.,

In promoting the school, we use students' images and samples of work. These might include photographs, videos/audio, quotations, students writing and artwork. We may interview, photograph, audiotape, videotape/film a variety of activities and events. Additionally, photographs accompanied by names of students and grade, may be used by local media, such as newspapers and television and radio stations.

This media release form requests your consent to use your student's image, words and work for official church and school purposes and your student's name should he/she be photographed or interviewed by local or regional media.

Parent, Legal Guardian or Other Adult Information
Additional adults in a household should complete separate permission agreements. Thank you.
Adult Name (First, Last)
Your answer
Minor Information
Please select the grade your child(ren) is entering August 2016
Child 1 Name (First, Last)
Your answer
Child 1 Grade
Child 2 Name (First, Last)
Your answer
Child 2 Grade
Child 3 Name (First, Last)
Your answer
Child 3 Grade
Child 4 Name (First, Last)
Your answer
Child 4 Grade
Child 5 Name (First, Last)
Your answer
Child 5 Grade
Once signed and dated this form shall remain in effect July 31, 2016 to August 30, 2017. At any point you may adjust this permission for future use by notifying, in writing, Mrs. Ananda Baron, Principal. Failure to submit this form will be regarded as "CONSENT" by Zion Lutheran Church & School.
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