Parental Photo/Video Release Form

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YSocialWork, Inc. is requesting permission for the use of images, video, photo, and digital recording of your child, captured during the High School Experiential Classroom, for the purposes of YSocialWork, Inc. promotional material and publications, and waive any rights of compensation or ownership thereto.

Name of Participant: *

Name of Parent/Guardian: *

Email of Parent/Guardian:

Phone Number of Parent/Guardian:

I hereby give permission for images of my child, captured during the High School Experiential Classroom, through video, photo, and digital camera, to be used solely for the purposes of YSocialWork, Inc. promotional material and publications, and waive any rights of compensation or ownership thereto. *

Yes, I give YSocialWork, Inc. permission and waiver any rights.

No, I do not give YSocialWork, Inc permission and uphold my rights.

Date: *

YYYY

Time *

Time

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