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Media Consent Form

Student's Name*

Answer Required

Parent/Guardian's Name*

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Parent/Guardian's Email or Phone Number*

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Media Consent

Fannie Lou Hamer Freedom High School students participate in many activities that may be photographed and/or recorded for video. We ask that you grant your persmission for your child to be recorded. No photographs or recordings will be used for profit making purposes.

I consent to the participation in interviews, the use of quotes, and the taking of photographs, audio and/or video recordings of my student.

Answer Required

Yes

I have questions about this.

I grant Fannie Lou Hamer Freedom High School 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 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.

Answer Required

Yes

I have questions about this

Acknowledgement

Digital Signature of Person Completing this Form*

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Date*

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