PS 123Q's Social Media Consent Form

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CONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE A STUDENT FOR NON-PROFIT USE
(e.g. educational, public service, or health awareness purposes)

Office of Communications and Media Relations
52 Chambers Street, New York, NY 10007
Tel: 212.374.5141 Fax: 212.374.5584

PLEASE READ CAREFULLY

I, the Parent of ________________________(*Please write your child's name below) *

hereby give consent for my child to participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes that are taken by PS 123Q for the time that my child's attends the school.

I, also, grant PS 123Q 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 also 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. *

Yes, I do grant PS 123Q the rights listed above.

This will allow us to showcase your child on the P.S. 123Q website, along with other social media platforms, for the outstanding achievements or work they have accomplished.

Signature/Name of Parent/Guardian: *

Address of Parent/Guardian:

Today's Date: *

YYYY

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