CONSENT TO PHOTOGRAPH, FILM OR VIDEOTAPE A STUDENT FOR NON-PROFIT USE
The Media Consent form must be signed by a parent or guardian to give permission for their child to be photographed, quoted, filmed, or videotaped for non-profit use (e.g.: educational, public service or health awareness purposes). Please complete form below and submit.
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Student First Name: *
Student Last Name: *
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 by A.C.E. Academy for Scholars ~ P.S. 290Q. I also grant to A.C.E. Academy for Scholars ~ P.S. 290Q 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. SPANISH TRANSLATION: Por la presente doy mi consentimiento para la participación en entrevistas, el uso de citas y la toma de fotografías, películas o cintas de video del Estudiante mencionado anteriormente por A.C.E. Academia para académicos ~ P.S. 290Q. También otorgo a A.C.E. Academia para académicos ~ P.S. 290Q el derecho a editar, usar y reutilizar dichos productos para fines sin fines de lucro, incluido el uso en forma impresa, en Internet y todas las demás formas de medios. Por la presente también libero al Departamento de Educación de la Ciudad de Nueva York y sus agentes y empleados de todos los reclamos, demandas y responsabilidades en relación con lo anterior. *
Required
Parent/Guardian Name (Nombre del Padre de Familia / Guardian): *
Address of Parent/Guardian (Dirección del padre / tutor): *
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