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Youth Retreat Photograph & Video Consent Form
The purpose of this parental consent form is to obtain consent for your child’s photo/video image to be shared with the community. Photographs and video images of students in the Youth Leadership Exploration Retreat are routinely taken for promotional purposes, celebrating student achievement and sharing educational programs with the community. Photographs may be submitted to area newspapers, used in district publications and/or posted on websites associated with Upscale Studio. Video footage may be submitted to area news outlets that usually cover these special events in the community.Pursuant to law, we will not release any photos/images of your child without your permission. It is essential, therefore, that this signed form be completed and turned in. If you wish to rescind or amend this consent at any time, contact Upscale Studio at 561-236-8625. Thank you for your cooperation.
Television/Newspapers
Check one of the following
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I/We GRANT permission for a photo/video image that includes this student to be shared with media outlets. Under no circumstances will we release personally identifiable information with such images,other than the child’s name, age, and/or grade.
I/We DO NOT GRANT permission for this student’s photo/video image to be posted on the websites associated with Upscale Studio.
Website
Check one of the following
I/We GRANT permission for this student’s photo/video image to be published on websites associated with Upscale Studio.
I/We DO NOT GRANT permission for this student’s photo/video image to be posted on the websites associated with Upscale Studio.
Name
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MI
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Name of Parent / Guardian
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First
Last
Today's date
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