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Parental Authorization Forms
Media Release Form
MEDIA RELEASE FORM
Student’s Name:
*
(First Name Last Name)
Grade:
*
- Select -
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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.
About Us
Temple Academy has been serving the Central Maine community with academic excellence for over 40 years!
Call to apply today!
207-873-5325
Address
60 West River Road
Waterville, ME 04901
Phone : 207 873-5325 | 207 660-4224
Email: school.office@templeacademy.org
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