Photo Consent Form
Consent to photograph, film, or videotape a student for non profit use (e.g. educational, public service, or health awareness)
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Student Last Name / APELLIDO / 姓氏 / لقب الطالب
Student First Name / PRIMER NOMBRE / 名字 / الإسم
I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the student named above. I also grant the right to edit, use, and reuse said products for non profit purposes including use in print, on the internet, and all other forms of media. I also hereby release the New York City Department of Education and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above
Parent/Guardian Signature / Firma del padre o tutor / 家長/監護人簽名 / توقيع الوالد (ة) / ولي الأمر
Address of Parent
A copy of your responses will be emailed to the address you provided.
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This form was created inside of PS 503: The School of Discovery (K503).