Media Authorization & Release Form
I, as the parent or legal guardian of the above-named student (“Student”), understand and acknowledge that during CORE Butte Charter School (“CORE Butte”) activities including but not limited to educational, athletic, outreach, fundraising, and/or extracurricular programs and activities, photographs, videos, audio and other recordings (“Recordings”) of students, parents/guardians, staff, employees and other attendees, participants and community members may be taken on campus or elsewhere. I understand that these Recordings may be used to describe or promote CORE Butte through various formats including but not limited to social media, the internet, websites, brochures, newsletters, campus displays, television, articles, reports, and other school-related promotion, fundraising and publicity activities and descriptive materials (“Media”). I understand and voluntarily agree that there will be no compensation of any kind received by those who appear in the Recordings or their families.

I hereby agree to the terms and conditions set forth in this form and voluntarily grant permission for CORE Butte to obtain and use Recordings of me and/or the Student for the purposes outlined in this form.  I hereby voluntarily grant CORE Butte permission to reproduce through printed, audio, visual, and/or electronic means CORE Butte activities in which the Student has participated and/or will participate. I understand that myself, my family and/or the Student may be photographed, videotaped, and/or recorded by staff, parents/guardians and others during CORE Butte activities. I understand that any and all Recordings may be used for marketing and/or media purposes, including but not limited to appearing in the Media listed above. I fully and voluntarily authorize and grant CORE Butte and its authorized representatives, the right to print, photograph, record, and edit as desired, the biographical information, name, image, likeness, and/or voice of the Student in Recordings, for the purposes stated or related to those listed above. I understand and agree that CORE Butte and/or its authorized representatives shall have the exclusive right, title, and interest, including copyright, in the Recordings. I understand and agree that CORE Butte and its authorized representatives shall have the unlimited right to use the Recordings for any purposes stated or related to the above.

I hereby release and hold harmless CORE Butte and its officers, Board of Directors, employees, attorneys, agents, representatives, volunteers, successors and assigns from any and all actions, claims, liabilities, damages, costs, and/or expenses, including attorney’s fees, that may be asserted or claimed by the Student and/or the Student’s parent(s) or guardian(s) which relate to or arise out the Recordings or any use thereof, as specified above. I understand that granting permission is voluntary.
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Student ID#
Student's First Name *
Student's Last Name *
Date of Birth *
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DD
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Address *
City *
Zip Code *
Student's Current Grade *
Your Name *
Relation to Student *
Contact Info *
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By completing this electronic form, I acknowledge that I am the parent or legal guardian of the Student and I have read, understand, and voluntarily agree to all the provisions and terms stated in this form. *
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