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Parental Authorization Forms

Media Release Form

MEDIA RELEASE FORM

Student’s Name: *

(First Name Last Name)

Grade: *

Yes, I grant my consent to Temple Academy to use my child’s likeness, my child’s photograph and/or reproductions, including my child’s voice features, with or without my child’s name for the purposes of news photos, classroom bulletin boards, school bulletin boards, school television broadcasts, or posting on the school’s website/social media pages. I agree that I am not entitled to compensation for any kind of arising from the use of my child’s likeness.

No, please do NOT use my child’s likeness, name or image for any purpose of news photos, classroom bulletins, school bulletins, television broadcasts, videos, or anywhere on the web.

Parent/Guardian Signature: *

(First Name Last Name)

*This form will cover the student for the duration of their time at Temple Academy.