FFA Program Media Release Form

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*This form should be filled out by the student(s)' parent or guardian ONLY.*

To the extent that proprietary rights in the design of a website hosted on the board’s servers as well as social media (i.e. Facebook) and other media outlets (Springfield News-Sun and Madison Messenger) would vest in my child (children) upon creation, I agree to assign the following rights to the board, school personnel and/or the FFA advisor;

Email *

Please check any or all of the following that applies: *

I give permission for my child’s image (photograph) or video to be published on the school & FFA website

I give permission for my child’s full name (first and last) to be published on the school & FFA website.

I give permission for my child’s image (photograph) or video to be published on news media websites and newspaper articles (i.e. Springfield News-Sun and/or Madison Messenger).

I give permission for my child’s full name (first and last) to be published on news media websites and newspaper articles (i.e. Springfield News-Sun and/or Madison Messenger).

I give permission for my child’s image (photograph) or video to be published on the FFA chapter Facebook & Instagram pages, Trojan Wall on Twitter or other school approved social media.

I give permission for my child’s full name (first and last) to be published on the FFA chapter FFA chapter Facebook & Instagram pages, Trojan Wall on Twitter or other school approved social media.

I do NOT give permission for any of the above options, unless otherwise noted below:

Required

(optional) I have the following restrictions for my student(s)' information:

Student(s) name(s): *

By typing my virtual signature below, I understand that all of the above options are intended to publicize and archive activities, results and events of the Southeastern FFA as a means of communication and information, and give my permissions as noted. *

Send me a copy of my responses.

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