LAUSD Parent/Guardian Publicity Authorization and Release
Dear Parent/Guardian:

The Los Angeles Unified School District requests your permission to reproduce through printed, audio, visual, or electronic means activities in which your pupil has participated in his/her education program. Your authorization will enable us to use specially prepared materials to (1) train teachers and/or (2) increase public awareness and promote continuation and improvement of education programs through the use of mass media, displays, brochures, websites, etc.
Name of Student *
Your answer
Birthdate of Student *
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Name of Parent *
Your answer
I, as a parent of guardian, of the above named pupil fully authorize and grant the Los Angeles Unified School District and its authorized representatives, the right to print, photograph, record, and edit as desired, the biographical information, name,image, likeness, and/or voice of the above named pupil on audio, video, film, slide, or any other electronic and printed formats,currently developed, (known as “Recordings”), for the purposes stated or related to the above. *
Required
I understand and agree that use of such Recordings will be without any compensation to the pupil or the pupil’s parent or guardian. *
Required
I understand and agree that the Los Angeles Unified School District and/or its authorized representatives shall have the exclusive right, title, and interest, including copyright, in the Recordings. *
Required
I understand and agree that the Los Angeles Unified School District and/or its authorized representatives shall have the unlimited right to use the Recordings for any purposes stated or related to the above. *
Required
I hereby release and hold harmless the Los Angeles Unified School District and its authorized representatives from any and all actions, claims, damages, costs, or expenses, including attorney’s fees, brought by the pupil and/or parent or guardian which relate to or arise out of any use of these Recordings as specified above. *
Required
Signature of Parent/Guardian *
My signature shows that I have read and understand the release and I agree to accept its provisions. Granting of permission is voluntary.
Your answer
Date Signed *
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Address (Number, Street, Apartment Number) *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Telephone *
Your answer
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