Media Release Form 2022-23

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The Office of Catholic Schools of the Diocese of Arlington (OCS) and any of its schools and/or the Arlington Catholic Herald may produce or participate in video tape, audio recording, website or still photograph productions that may involve the use of students’ names, likenesses, or voices. Such productions may be used for educational and/or official school marketing purposes and may be copied or copyrighted with the school retaining any and all rights to such productions.

You have the right to prohibit the use of your child’s name, picture or voice in these productions and may do so by completing the form below. Please read the options below carefully as you consider your decision and electronically sign this form. If the form is not returned by August 16, we will assume that you do not prohibit such use. This agreement is binding for the 2021-22 school year. No adaptations, changes or alterations may be made for the 2021-2022 academic year.

Please note that by objecting to Image and Identity below your student would not be included in video recorded plays and productions, snapshots of classroom celebrations, the annual school Christmas card, classroom newsletters or parish bulletins.

After clicking submit you will see the option to add another response for additional children.

Email *

Student First Name *

Student Last Name *

Student Grade *

Identity *

I DO authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use MY Child’s Name identifying them in photographs, videos and/or audio recordings for educational, news stories, illustration and/or marketing purposes.

I DO NOT authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use MY Child’s Name identifying them in photographs, videos and/or audio recordings for educational, news stories, illustration and/or marketing purposes.

Image and Audio *

I DO authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use and publish my child’s photograph, video and/or audio recording for educational, news stories, illustration and/or marketing purposes.

I DO NOT authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use and publish my child’s photograph, video and/or audio recording for educational, news stories, illustration and/or marketing purposes EXCEPT for the school yearbook.

Date *

YYYY

Parent Electronic Signature *

Parent email address *

Students and parents will sign a Media Release Form each year. The administration is responsible for monitoring compliance with the policy.

A copy of your responses will be emailed to the address you provided.

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