Child Media Consent Form

Note: You have the option to print the Child Media Consent Form

PARENTAL 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.

Name(s) of Child(ren) (First/Last): *

Media Authorization *

I/we authorize the above child(ren)’s name, images or video to be used in print or the school website for the sole purpose to recognize an achievement of the child(ren) or for the promotion of the school.

I/we do not authorize the above child(ren)’s name, images or video to be used in print or the school website for the sole purpose to recognize an achievement of the child(ren) 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 of parent/guardian *

Media Consent Date *

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Child Media Consent Form

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

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