Adult Media Consent Form

ADULT CONSENT AND RELEASE FOR PUBLIC RELATIONS, INTERNET/WEBSITE INFORMATION

SCHOOL YEAR 2022-23

From time to time, the Greek Language School may include student images or website media published by the school or the Cathedral.

Student Name (First/Last): *

Media Authorization *

I authorize my name, images or video to be used in print or the school website for the sole purpose to recognize an achievement of me or for the promotion of the school.

I do not authorize my name, images or video to be used in print or the school website for the sole purpose to recognize an achievement of me or for the promotion of the school.

Agree Signature Media Consent *

By checking this box, I agree to the use of my electronic signature and agree that the electronic signature is valid and has the same effect as a written signature on a paper copy of this document.

Print name *

Media Consent Date *

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Adult Media Consent Form

ADULT CONSENT AND RELEASE FOR PUBLIC RELATIONS, INTERNET/WEBSITE INFORMATION

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